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The chapter then describes the four subtypes of MS and the tests used to diagnose
the disorder.
Copyright 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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The chapter then reviews the two groups of drugs used to treat the symptoms of MS,
reduce the frequency and severity of relapse, and treat acute episodes.
Disease-modifying drugs can reduce the frequency and severity of relapses, the
development of brain lesions, and future disability, and they may help maintain
quality of life. In addition, they may prevent permanent damage to axons.
The two main groups of disease-modifying drugs are immunomodulators and
immunosuppressants. The immunomodulatorsinterferon beta, glatiramer
acetate, natalizumab, and fingolimodare much safer than mitoxantrone (the
major immunosuppressant in use) and therefore are generally preferred.
All patients with relapsing-remitting MS, regardless of age, frequency of attacks,
or level of disability, should be treated with one of the immunomodulators.
Treatment should begin as soon as possible after relapsing-remitting MS has been
diagnosed, because early treatment can help prevent axonal injury and thereby may
prevent permanent neurologic deficits. Treatment should continue indefinitely.
Interferon beta can benefit certain patients with secondary progressive MS,
specifically those who still have acute relapses. For these individuals,
interferon beta can reduce the severity and frequency of attacks and the
development of MRI-detectable brain lesions.
Mitoxantrone can reduce the clinical attack rate and the development of new brain
lesions and slow the progression of disability in secondary progressive MS.
However, although the drug is effective, cardiotoxicity precludes its long-term
use.
Copyright 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Mitoxantrone is the only disease-modifying drug approved for progressiverelapsing MS. Unfortunately, its benefits generally are modest.
No disease-modifying therapy has been shown effective against primary
progressive MS.
A short course of a high-dose IV glucocorticoid is the preferred treatment of an
acute relapse. Glucocorticoids suppress inflammation and can thereby reduce the
severity and duration of a clinical attack.
Acute relapse may also be treated with IV gamma globulin. This option can be
especially helpful in patients intolerant of or unresponsive to glucocorticoids.
The chapter then discusses the immunomodulators and their possible side effects.
The chapter continues with a discussion of individual drugs and their side effects.
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Fingolimod can cause multiple adverse effects. The most common are headache,
diarrhea, cough, back pain, influenza, and elevation of liver enzymes. The most
serious are bradycardia, macular edema, infection, fetal harm, and liver injury.
Fingolimod causes a 20% to 30% decrease in circulating lymphocytes and thus
increases the risk of infection.
Fingolimod is teratogenic and embryolethal in animals at doses equivalent to
those used clinically; there are no well-controlled studies in pregnant women.
Women of child-bearing age should be informed of the risk of fetal harm and
advised to use two effective forms of contraception both during treatment and for
2 months after the cessation of therapy.
Fingolimod can cause a dose-dependent decrease in lung function.