| Abstrakt: |
Many patients with multiple sclerosis (MS) experience significant breakthrough disease despite ongoing treatment with first-line diseasemodifying agents. The management of breakthrough disease requires consideration of the potential causes of new MS exacerbations and the selection of an appropriate therapy. Poor treatment adherence is an important barrier for many patients, and may occur as a result of numerous patient-related, physician-related, or medication-related factors. Strategies to enhance treatment adherence include effective patient education about the likely benefits of therapy and the importance of using medications as prescribed, as well as the use of specific measures to help patients overcome adverse effects of disease- modifying drugs. Some patients who are treated with interferon (IFN) b experience treatment failure as a result of the formation of neutralizing antibodies to IFN. There is little information about the effectiveness of switching between first-line treatments for patients with MS who are not responding adequately to therapy. Switching to natalizumab is an option for patients with continued disease activity, although the potential for progressive multifocal leukoencephalopathy is a significant cause for concern. Patients with breakthrough disease may benefit from the addition of a second medication to the treatment regimen, although combination therapy for MS has not been extensively studied in controlled clinical trials. Immunomodulatory therapy with pulsed corticosteroids is often added to the initial disease-modifying agent. Intravenous immunoglobulin (IVIG) is used by some clinicians, although there is little evidence that IVIG reduces long-term disability. Several cytotoxic agents have been used to treat breakthrough disease, including mitoxantrone, azathioprine, mycophenolate, and methotrexate. The oral lymphocytotoxic agent cladribine is currently being evaluated in late-phase clinical trials for the treatment of MS. Alemtuzumab, a monoclonal antibody against the CD52 cell-surface marker, has produced promising results in early clinical studies. All of these treatment options require careful consideration of the potential for significant adverse events. [ABSTRACT FROM AUTHOR] |
