Multiple Sclerosis Disease-Modifying Therapies

         Therapy was given only to minimize the incidence of attack, reducing the effects of attacks, and prolong remission. Disease-modifying therapies for early management of MS is currently available in the United States: intramuscular interferon beta-1a (Avonex), subcutaneous interferon beta-1a (Rebif), interferon beta-1b (Betaseron), and glatiramer acetate (Copaxone). The fifth agent, mitoxantrone (Novantrone), has been approved by the Food and Drug Administration (FDA) for the treatment of relapsing-remitting MS and secondary progressive MS is deteriorating. 

1. Interferon beta. 

       Interferon beta is a natural cytokine that has a function as immunomodulatory and antiviral activity. Three FDA-approved interferon beta used for MS has been shown to reduce the recurrence about a third and is recommended as first-line therapy for patients who are intolerant or with relapsing-remitting glatiramer the MS. In a randomized double-blind study, placebo controlled trials, the use of interferon beta can reduce 50 to 80 percent of inflammatory lesions visualized on MRI of the brain. There is also evidence that these drugs improve the quality of life and cognitive function. 

        The main difference of this type of medication is that interferon beta interferon beta-1a given once a week intramuscular and subcutaneous interferon beta-1a and interferon beta-1b administered three times a week, or each other every day. One study using a double-dose (60 mcg) of intramuscular interferon beta-1a given once a week did not provide benefits if use single dose regimen. There is an increasing incidence of neutralizing antibodies with subcutaneous dose should also be considered. 

        Influenza-like symptoms such as fever, chills, malaise, muscle aches, and fatigue, occurs in approximately 60 percent of patients treated with interferon beta-1a or interferon beta-1b. These symptoms usually disappear with continued therapy and premedication with anti-inflammatory non-steroidal. To reduce the symptoms can be done by setting the dose titration, at the time of initial administration of interferon beta therapy. Other side effects of interferon beta include an allergic reaction at the site of injection, depression, mild anemia, thrombocytopenia, and increased levels of transaminases. These side effects are usually not severe and rarely led to discontinuation of treatment.

2. Glatiramer. 

          This drug is a mixture of polypeptides that were originally designed to mimic and compete with myelin basic protein. Its mechanism of action is different from interferon beta, so patients can respond differently to the drug. Glatiramer in a dose of 20 mg subcutaneously once daily has been shown to reduce the frequency of MS relapses about a third. The drug is also recommended as first-line treatment in patients with Relapsing - Remitting MS and for patients who can not tolerate interferon beta. Results of glatiramer therapy can reduce inflammation third of that seen in MRI.

        Glatiramer, generally well tolerated and does not cause influenza - like symptoms. Post- injection reactions including local inflammation and general reactions such as flushing, chest tightness with palpitations, anxiety, or dyspnea may recover spontaneously without sequelae. Routine laboratory monitoring is not required in patients treated with glatiramer, and the ability of antibodies to bind to antigens is also not disturbed. 

3. Mitoxantrone. 

      A phase III clinical study of a multicenter randomized placebo control trial found that mitoxantrone, an anthracenedione antineoplastic agent, can reduce the number of MS relapses by 67 percent and slows the progression. Mitoxantrone is recommended for use in patients with progressive forms of MS. Acute side effects include nausea and alopecia mitoxantrone. Because of the presence also of cumulative cardiotoxicity, the drug can be used only for two to three years (or for a cumulative dose of 120-140 mg per m2). Mitoxantrone is a chemotherapeutic agent that should be prescribed and administered by an experienced health care professional. 

4 . New drugs and other medications. 

           Natalizumab ( Antegren ) are in the final stages of phase III clinical trials and is being reviewed by the FDA . In a phase II clinical trial, 33 this drug is able to promise in terms of reducing active MRI lesions by 90 percent and decrease the relapse of MS more than 50 percent. Natalizumab is a monoclonal antibody directed against an adhesion molecule VLA - 4. The drug is administered intravenously once a month. Although the FDA does not agree and definitive evidence of the efficacy of several other drugs commonly used in patients with MS, there are a number of simple clinical effects of the intravenous administration of IgG, azathioprine, methotrexate, and cyclophosphamide, either alone or in combination with standard therapy. 

           

           Researchers in Argentina who studied the benefits of vitamin D on MS disease found that Vitamin D appears to have a role in improving the state of MS patients is also associated with the immune system. The results of this study have been published in the journal Neurology in December 2011 issue of Science. Levels of 25 ( OH ) vitamin D and 1,25 ( OH ) ( 2 ) Vitamin D as measured by ELISA were significantly lower in patients with Relapsing - Remitting MS than in controls. In addition, levels in patients who relapse was also lower than during remissions. Whereas in patients with Primary Pogressive MS showed similar values to the control. Proliferation of the two new isolates of CD4 + T cells and MBP -specific T cells was significantly inhibited by 1,25 ( OH ) ( 2 ) - vitamin D. Overall/Collectively, these findings suggested that 1,25 ( OH ) ( 2 ) - vitamin D plays a role in T cell homeostasis in multiple sclerosis , so that correction of vitamin D deficiency states/lack of it can be useful for the treatment of multiple sclerosis disease