Advances in the treatment of relapsing - Remitting multiple sclerosis

ultiple sclerosis (MS) is a chronic, immune-mediated disease of the central nervous system (CNS).Pathologic hallmarks of MS lesions are inflammation, demyelination, axonal degeneration, neuronal loss, and gliosis.[1,2] MS is the most common neurological non-traumatic cause of disability in young people in the western world.MS initially presents in most patients as a relapsing-remitting condition (RRMS), but the majority of RRMS individuals develop a secondary progressive course (SPMS) later.[3] In fewer cases, the disease progresses from the beginning without superimposed relapses [primary progressive MS (PPMS)] or with rare superimposed relapses [progressive relapsing MS (PRMS)].[4] The clinical signs in MS can occur in isolation or in combination, and can include motor and sensory deficits, partial or complete visual loss, diplopia, impaired coor-dination, and gait dysfunction.The diagnosis specifically integrates magnetic resonance imaging (MRI) with clinical attacks and paraclinical methods, and implies the dissemination of inflammatory activity in time and space.[5] MS treatments tackle separately the acute exacerbations and their prevention.Pharmacological management of relapses involves the use of corticosteroids, while approved long-term treatments [disease-modifying treatments (DMTs)] aim to decrease the clinical relapse rate and concomitant inflammation within the CNS.MS therapeutic landscape is changing rapidly.After several years in which first-line DMTs -glatiramer acetate (GA) and interferon β (IFNβ) -constituted the principal treatment options, a variety of new agents for MS treatment are now approved by regulatory authorities or in phase II and III clinical trials.[6] In 2010, fingolimod, the first oral agent, Special EditionThis article reviews and discusses the approved and emerging therapies for multiple sclerosis (MS).MS is a chronic and disabling immune-mediated disease of the central nervous system (CNS) that affects mainly young adults.MS imposes a huge economic burden on healthcare systems and the society.Although the last 20 years have brought a continuous expansion in therapeutic options, there are still unmet needs in MS management.Available MS drugs have varying degrees of efficacy in reducing relapse risk.The long-term term effects of these treatments are incompletely known.New therapies, along with variations of currently available treatments, may prove more effective and tolerable than the available drugs.Treatments for MS differ with respect to the mode of administration, tolerability and likelihood of treatment adherence, side effects, and risk of major toxicity.The armamentarium of approved disease-modifying therapies in MS and those in development include: (1) the first approved, moderately effective, injectable interferon-β and glatiramer acetate; (2) oral drugs (fingolimod, laquinimod, teriflunomide, dimethyl fumarate); (3) monoclonal antibodies (rituximab, ocrelizumab, ofatumumab, daclizumab, alemtuzumab); and (4) immunosuppressive agents (e.g.mitoxantrone).The place of each drug in the therapeutic algorithm is dependent on its specific risk-benefit profile.Patients' clinical and paraclinical phenotypes and biomarker profile may help to elucidate disease subtypes and response to therapy in the future, thus allowing treatment individualization.