By John Gever, Managing Editor, MedPage Today
Reviewed by F. Perry Wilson, MD, MSCE; Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Although the drug development pipeline still contains numerous products intended for patients with relapsing-remitting multiple sclerosis (RRMS), the consensus among clinicians is that relapses can be effectively squelched in nearly all RRMS patients with the dozen or so currently approved therapies.
Patients now have a choice between injectables and oral drugs, and within the injectable class there is a range of dosing intervals and delivery types — expanded recently with the approval of alemtuzumab (Lemtrada) that requires just two brief courses of therapy a year apart.
The more pressing clinical need now, researchers told MedPage Today, is for treatments that stop or reverse the progressive forms of MS. This has been a tougher nut to crack because the mechanisms underlying progressive MS are less well understood than the acute demyelinating attacks that characterize RRMS. A particularly important aspect that remains mysterious is the switch that occurs in many patients from RRMS to the secondary progressive form or SPMS.
Currently the sole FDA-approved treatment for SPMS is the chemotherapeutic agent mitoxantrone, which has only been tested in two small trials of questionable design that showed relatively modest efficacy. The drug also has significant toxicities that earned a lengthy boxed warning on its label.
But that doesn’t mean MS researchers haven’t made any progress — in fact, enough knowledge about progressive MS has accumulated that rational approaches to therapy are now in clinical development. The following is a rundown, aided by Jeffrey Cohen, MD, who spoke at length recently with MedPage Today. Cohen is director of the experimental therapeutics program in the Cleveland Clinic’s Mellen Center for Multiple Sclerosis.
He summarized the field’s current status in progressive MS this way: “There are now a lot of candidate approaches being considered and we’re finally starting to test them.”
Jumpstarting Oligodendrocyte Activity
One firmly established feature of advanced MS is that the physical disability results from destruction of nerve axons following demyelination — the process that defines MS in all its forms, stripping away the protective myelin sheaths from axons.
For the Full Story Click http://www.medpagetoday.com/Neurology/MultipleSclerosis/48725
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