Since MS is not a curable disease. Treatment regimens are currently targeting symptom management and slow down disease progression. In RRMS, the main aim behind treating patients is to reduce the frequency and severity of relapses. In addition, recent studies have shown that early treatment with Disease- modifying Therapies (DMTs) is associated with significant improvement in the patient’s quality of life.14 Ideally, treatment goals of RRMS are to: treat acute relapses, improve health-related QOL, reduce the frequency and severity of relapses, delay disability accumulation, and postpone the onset of the progressive phase of the disease.15,17 For example, when acute exacerbations occur (such as vision loss or loss of coordination), they are …show more content…
Clinical guidelines for treatment of MS is still underdeveloped since that the American Academy of Neurology (AAN) and the MS Council for Clinical Practice Guidelines have not published comprehensive guidelines including all current DMTs in the US since 2002.18 At that time, fingolimod, teriflunomide, dimethyl fumarate, pegylated interferon beta-1a, glatiramer acetate 40 mg, natalizumab, and alemtuzumab were not commercially available. Unlike US, in Britain the Association of British Neurologists (ABN) has published MS treatment guidelines in 2015.22 The ABN clinical guideline has classified treatment options into two main categories: drugs of moderate efficacy (‘Category 1’) which include the following agents: beta- Interferons (IFNs-ß including ‘pegylated’ β-interferon), glatiramer acetate, teriflunomide, dimethyl fumarate, and fingolimod. Drugs of high efficacy (‘Category 2’) which are: alemtuzumab and natalizumab. As recommended by the ABN clinical guidelines, patients with RRMS should be started on category 1 drugs as soon as possible to prevent permanent neurological damage; as they were considered very effective in reducing relapse rate and MRI lesion accumulation to varying extents. 22 Dimethyl fumarate and fingolimod are the more effective drugs in this category, with the advantage of being oral agents.22 Patients who experience an aggressive form of RRMS or failed to respond to first line …show more content…
The ANN in their guidelines report19 has classified treatment into three main categories: anti-inflammatory, immunomodulatory, and immunosuppressive therapy. Immunomodulatory treatment includes: injectable Interferon beta (IFN-ß) and Glatiramer acetate (Copaxone®) which are considered as first line therapy to treat relapsing forms of MS. IFN- ß is available in three forms: IFN- ß 1a (Avonex®), IFN- ß 1b (Betaseron®) and IFN- ß 1a (Rebif®). Although the precise mechanisms through which IFN- ß achieves its anti-inflammatory and immunomodulatory effects remain uncertain, several modes of action have been proposed. Dominant MOA was believed to be modulation of the immune system by reducing T cell migration from the periphery into the CNS by decreasing the production of adhesion molecules and increasing the production of metalloproteases on the vascular endothelium that constitutes the blood brain barrier.20 Betaseron® was the first agent approved by the FDA in 1993 for the treatment of RRMS. The recommended dose is 250 mcg SC every other day. Following Betaseron®, Avonex® was approved in 1996 with a dose of 30 mcg IM once a week. Rebif® was approved in 2002 with a dose of 44 mcg SC 3 times weekly. IFNs have similar adverse effects which can include: Flu-like symptoms, injection site reaction, allergic reaction,