Different Forms Of Multiple Sclerosis Research Articles

Comprehensive analysis of ocrelizumab's efficacy across different forms of multiple sclerosis: a multi-dimensional approach

BackgroundMultiple sclerosis (MS) is the most common immune-mediated inflammatory demyelinating disease of the central nervous system. MS usually affects individuals between the ages of 20 and 40 and is 3 times more common among women than among men. This disease presents with a vast range of neurological symptoms and, in some cases, cognitive impairment. Aim of the studyThe purpose of this review was to assess whether the anti-CD20 antibody ocrelizumab has proven effective in treating MS since its introduction.Material and methodsThe PubMed database was searched for original papers on the effects of ocrelizumab in the treatment of MS. The inclusion criterion was a comparison of the clinical or radiological effectiveness of ocrelizumab versus placebo or other MS therapies. For this purpose, the phrase "Ocrelizumab AND Multiple Sclerosis" was used, marking only studies such as "Randomised Clinical Trial" and "Clinical Trial". The cut-off point for publishing the work was 2016.Results43 works were found, of which 15 met the conditions for inclusion in the work. The analysed studies investigated the efficacy and safety of ocrelizumab in Relapsing Multiple Sclerosis, Primary Progressive Multiple SclerosisConclusionsThe effectiveness of ocrelizumab treatment shows that the use of newly developed targeted factors may significantly improve the clinical status of MS patients. Preliminary real-world data on the efficacy of ocrelizumab are promising and align with clinical trial findings. Although ocrelizumab is generally well tolerated, it is essential to monitor and assess its long-term safety.

Integrating Rehabilomics into the Multi-Omics Approach in the Management of Multiple Sclerosis: The Way for Precision Medicine?

Over recent years, significant improvements have been made in the understanding of (epi)genetics and neuropathophysiological mechanisms driving the different forms of multiple sclerosis (MS). For example, the role and importance of the bidirectional communications between the brain and the gut-also referred to as the gut-brain axis-in the pathogenesis of MS is receiving increasing interest in recent years and is probably one of the most promising areas of research for the management of people with MS. However, despite these important advances, it must be noted that these data are not-yet-used in rehabilitation. Neurorehabilitation is a cornerstone of MS patient management, and there are many techniques available to clinicians and patients, including technology-supported rehabilitation. In this paper, we will discuss how new findings on the gut microbiome could help us to better understand how rehabilitation can improve motor and cognitive functions. We will also see how the data gathered during the rehabilitation can help to get a better diagnosis of the patients. Finally, we will discuss how these new techniques can better guide rehabilitation to lead to precision rehabilitation and ultimately increase the quality of patient care.

Vitamin D Receptor and Its Influence on Multiple Sclerosis Risk and Severity: From Gene Polymorphisms to Protein Expression

Multiple sclerosis (MS) is a multifactorial neurodegenerative disease. Low levels of vitamin D are a risk factor for MS and alterations in the vitamin D receptor (VDR) might be a risk factor as well. This study aimed to evaluate whether the VDR rs731236 (Taq-I) and rs4334089 (HpyCH4V) gene polymorphisms and VDR protein expression are associated with MS risk and severity. Vitamin D plasma levels were analyzed in a group of patients. Additional analyses of VDR protein expression and vitamin D levels of patients with different forms of MS (MSSS < 3 and MSSS ≥ 3) were performed. The analysis of the genotypic and allelic frequencies revealed that the rs731236 (Taq-I) gene polymorphism is significantly associated with MS presence. Although the total, cytosolic and nuclear VDR protein contents do not change between MS patients and healthy controls and between patients with different MS severity, vitamin D levels decrease in parallel with an increase in MSSS.

Клинико-математический анализ различий для разных типов течения при спорадической и семейной формах рассеянного склероза

Актуальность. В работе на основе создания реестра семейных форм рассеянного склероза (РС) на модели Харьковского региона изучены особенности разных типов течения (рецидивирующего (РТ), вторично-прогредиентного (ВПТ), первично-прогредиентного (ППТ)) при спорадической и семейной формах заболевания. С помощью метода анкетирования изучены клинические показатели, характеризующие различные временные этапы при разных типах течения РС: доклинический этап, дебют, полнота и длительность ремиссий после дебюта, рецидивирующий этап для РТ и ВПТ, пути формирования этапа прогрессирования для ВПТ и ППТ, этап прогрессирования, включая такие его варианты, как неуклонный, рецидивирующий, поступательный, и темпы прогрессирования. С помощью клинико-математического анализа (метод пермутации) были получены достоверные клинико-диагностические различия в структуре клинических показателей на каждом этапе течения для спорадической и семейной форм РС. Материалы и методы. Обследован 131 больной, в том числе 87 (18 мужчин и 69 женщин) со спорадической формой и 44 (16 мужчин и 28 женщин) с семейной формой. При спорадической форме у 55 больных наблюдалось РТ, у 25 — ВПТ, у 7 — ППТ; при семейной форме у 22 больных — РТ, у 15 — ВПТ, у 7 — ППТ. Результаты. При РТ для спорадической формы, в отличие от семейной, чаще встречался благоприятный прогноз с достоверным преобладанием олигосиндромных дебютов и коротких рецидивов с быстрыми темпами развития на рецидивирующем этапе. При семейной форме, в отличие от спорадической, преобладал неопределенный прогноз, при котором чаще встречались (р < 0,05) предвестники дебюта, сфинктерные нарушения в дебюте, длительные рецидивы с замедленными темпами формирования. При ВПТ для спорадической формы неопределенный характер прогноза формировался благодаря таким клиническим показателям, как короткие дебюты, длительные ремиссии после дебюта, рецидивирующий вариант прогрессирования, преобладание пирамидной и мозжечковой симптоматики на этапе прогрессирования. При семейной форме и неблагоприятном прогнозе преобладали тяжелый и длительный дебют, сфинктерные нарушения и атипичные синдромы в дебюте, формирование ВПТ непосредственно после дебюта, минуя рецидивирующий этап. При ППТ для спорадической формы с неопределенным прогнозом были характерны длительный дебют, наличие этапа стабилизации после дебюта, стволовая симптоматика на этапе прогрессирования. При семейной форме преобладал неблагоприятный прогноз, который характеризовался олигосиндромным и неопределенным по длительности дебютом и формированием этапа прогрессирования непосредственно после дебюта. Выводы. Полученные паттерны клинических показателей, выделенные при разных формах РС, свидетельствуют о более неблагоприятном прогнозе для всех типов течения семейной формы по сравнению со спорадической, в первую очередь для прогредиентных типов течения.

Perceptions of fatigue and fatigue management interventions among people with multiple sclerosis: a systematic literature review and narrative synthesis

Background/Aims Fatigue is the most common symptom of multiple sclerosis. Evidence supports the effectiveness of fatigue management interventions for people with multiple sclerosis. This review aimed to identify how people with multiple sclerosis experience fatigue and to examine their perceptions of fatigue management interventions. Methods The review was conducted systematically, searching the following electronic databases: AMED, CINAHL Complete, eBook Nursing Collection, ERIC, Health Source: Nursing/Academic Edition, MEDLINE, APA PsycArticles, and APA PsycInfo for original peer-reviewed empirical research published in English between January 2000 and June 2020. Qualitative and mixed-methods studies that captured the perspectives of people with multiple sclerosis on their fatigue and/or their perceptions of fatigue management interventions were included. A narrative synthesis was used to synthesise the findings. Results A total of 23 qualitative and eight mixed-methods studies were extracted comprising a total of 662 people with multiple sclerosis (relapsing remitting n=293; secondary progressive n=129; primary progressive n=73; relapsing progressive n=3; benign n=2; fulminant n=1; type of multiple sclerosis not reported n=161). Fatigue was perceived by people with multiple sclerosis as a debilitating symptom of the condition and which they felt impacted adversely on their lives. A lack of understanding from others about multiple sclerosis fatigue was challenging for people with multiple sclerosis. People with multiple sclerosis valued the physical and psychosocial-based content of fatigue management interventions and felt fatigue management interventions enabled them to legitimise their fatigue and feel more in control of their fatigue. Conclusions From the perspective of people with multiple sclerosis, fatigue is a central and debilitating feature of the everyday experience of living with multiple sclerosis. Research on the potential of fatigue management interventions to foster control for people with multiple sclerosis to help them manage their fatigue is warranted. Healthcare professionals should consider how they can empower people with multiple sclerosis to educate others about their fatigue. Some evidence being generated for practice might not be sufficiently contextualised to different forms of multiple sclerosis.

Thalamic atrophy correlates with dysfunctional impulsivity in multiple sclerosis

BackgroundRecent studies highlight the central role of thalamic atrophy in Multiple Sclerosis (MS) related disorders. Behavioural aspects of (MS) are rarely explored but their investigation is of high interest. Dickman's Impulsiveness Inventory (DII) allows distinguishing functional impulsivity (FI) which is the ability to react fast and properly when necessary, from dysfunctional impulsivity (DI) which is a behavioural symptom corresponding to the tendency to miss forethought before acting. ObjectiveThis paper aims to explore whether MS patients show significantly high and pathological DI, and to evaluate the impulsivity frequency in the different forms of MS including at the early stage of the Clinically Isolated Syndrome. Furthermore, this study focused on the factors that may induce abnormal impulsivity, and the link between thalamic atrophy and dysfunctional impulsivity in patients with MS. Methods95 patients with demyelinating diseases including 21 Clinically Isolated Syndrome (CIS), 30 Relapsing-Remitting MS (RRMS), 23 Secondary Progressive MS (SPMS) and 21 Primary Progressive MS (PPMS) were prospectively recruited, and covered by extensive cognitive evaluation including the BCCogSEP (French version of the Brief Repeatable Battery for Neurological disease), the CSCT (Computerized Speed Cognitive Test) for processing speed of information (PSI), the DII to measure FI and DI, the Fast BDI to evaluate depression, and the EMIF-SEP scale to study physical, cognitive and social fatigues. 3D T2-FLAIR and 3D T1-weighted MRI were analyzed using automatic segmentation tools to quantify the T2 lesion load and to measure the whole and regional brain atrophy. Results7% showed a pathologically high DI. The level of DI tended to differ significantly depending on the MS phenotype. There was no significant difference between RRMS, SPMS and PPMS, but RRMS showed significantly higher DI than CIS patients. Cognitive fatigue (r:-0.27, p<.01), depression (r:-0.21, p=.04) but mainly PSI (r:.33, p<.001) showed a significant correlation with DI. Among the brain regions of interest, the strongest significant correlation with DI was with thalamic atrophy (r:.33, p<.001). ConclusionSome MS patients show a pathologically high DI, mainly RRMS compared to CIS. Previous study highlighted impulsive traits in MS patients only in relation with the presence of depression. The present study demonstrates that depression tends to correlate with DI, but that cognitive fatigue, and mainly slowing of PSI, which is the most early and severe cognitive impairment in MS, have a stronger impact on the rise of pathological impulsive behaviour. DI in MS is linked to frontal regions but even more strongly to thalamus atrophy. This is in line with the hypothesis of a disconnection syndrome in MS that causes cognitive impairment to trigger and could have the same impact on behaviour. Hence, impulsive behaviour should be evaluated and taken into account in the care of patients with MS.

In Silico and In Vivo Analysis of IL37 in Multiple Sclerosis Reveals Its Probable Homeostatic Role on the Clinical Activity, Disability, and Treatment with Fingolimod.

We evaluated the in silico expression and circulating levels of interleukin (IL)37 in patients with different forms of multiple sclerosis (MS) and also upon treatment with different disease-modifying drugs. The combined interpretation of the resulting data strengthens and extends the current emerging concept that endogenous IL37 plays an important role in determining onset and progression of MS. The in silico analysis revealed that production of IL37 from cluster of differentiation (CD)4+ T cells from MS patients was reduced in vitro as compared to healthy controls. The analysis of the datasets also demonstrated that “higher” levels of IL37 production from PBMC entailed significant protection from MS relapses. In addition, the in vivo part of the study showed that IL37 was selectively augmented in the sera of MS patients during a relapse and that treatment with the high potency disease-modifying drug fingolimod significantly increased the frequency of patients with circulating blood levels of IL37 (6/9, 66%) as compared to patients receiving no treatment (n = 48) or platform therapy (n = 59) who had levels of IL37 below the limit of the sensitivity of the assay. This finding therefore anticipates that fingolimod may at least partially exert its beneficial effects in MS by upregulating the production of IL37.

Cognitive disorders in patients with multiple sclerosis

The subject of the article is defined by the relevance and recognition of the importance of early diagnosis of different cognitive and emotional disturbances in patients with multiple sclerosis. This allows appropriate treatment and improve the prognosis of the disease. The article presents a review of the pathogenesis and new theories about cognitive impairment in patients with different forms of multiple sclerosis. The author proposes a holistic treatment where treatment integral includes not only of multiple sclerosis, but also an approach that includes treatment of all pathologies present in the patient, the family, society and the health system.

Two Sides to Every Story: Perspectives from Four Patients and a Healthcare Professional on Multiple Sclerosis Disease Progression.

Multiple sclerosis (MS) is a chronic progressive disease and many patients transition from an initial relapsing–remitting course to a secondary progressive pattern. Accurate classification of disease status is critical to ensure that patients are treated appropriately and kept informed of their prognosis. Consensus terms defining the different forms of MS are available but were developed primarily for healthcare professionals (HCPs) and may be of limited value to patients. This article provides direct insights from four patients with MS, at different points in their disease trajectory, regarding their understanding of, and attitudes toward, MS progression. We also examine the utility of the current classification systems from the perspectives of patients and HCPs. Responses collected during in-depth, structured interviews and questionnaires portrayed the difficulties patients face accepting their MS diagnosis and treatment, revealed how understanding of the term “disease progression” varies considerably, and highlighted the challenges surrounding the period of transition to secondary progressive MS (SPMS). The terms describing different MS types were considered confusing and can make patients feel “compartmentalized” or “labeled”. Patients also struggled to relate these terms to their reality of living with MS, were reluctant to discuss progression with their HCPs, and feared being diagnosed with SPMS owing to concerns about treatment access. These insights highlight the need to develop patient-friendly language to describe MS progression; it may also be preferable for HCPs to describe MS as a disease spectrum in discussions with their patients.FundingNovartis Pharmaceuticals Corporation.Plain Language SummaryPlain language summary available for this article.

Sleep Disturbances – an Important Factor in Combination with “Minor” Symptoms of Multiple Sclerosis

Objectives. To study the clinical and neurophysiological features of sleep disturbances in patients with different forms of multiple sclerosis (MS) and their effects on quality of life and the course and prognosis of illness; to identify the influences of sleep disturbances on the formation and maintenance of chronic fatigue syndrome in MS patients. Materials and methods. A total of 54 patients with different forms of MS and 54 healthy volunteers were studied. General clinical investigation methods were used, along with neuropsychological testing (detection of anxious-depressive states), subjective sleep quality assessment scales (assessment of the severity of daytime drowsiness, chronic fatigue syndrome, quality of life measures), and their subsequent relationship with neuroimaging and neurophysiological data. Results and discussion. Analysis of the data revealed a high frequency of sleep disturbances associated with anxiety disorders and other comorbid pathologies which occur significantly more frequently among MS patients.

Consensus statement on the treatment of multiple sclerosis by the Spanish Society of Neurology in 2016

With the advent of new disease-modifying drugs, the treatment of multiple sclerosis is becoming increasingly complex. Using consensus statements is therefore advisable. The present consensus statement, which was drawn up by the Spanish Society of Neurology's study group for demyelinating diseases, updates previous consensus statements on the disease.The present study lists the medications currently approved for multiple sclerosis and their official indications, and analyses such treatment-related aspects as activity, early treatment, maintenance, follow-up, treatment failure, changes in medication, and special therapeutic situations.This consensus statement includes treatment recommendations for a wide range of demyelinating diseases, from isolated demyelinating syndromes to the different forms of multiple sclerosis, as well as recommendations for initial therapy and changes in drug medication, and additional comments on induction and combined therapy and practical aspects of the use of these drugs.

Sleep disturbances - an important factor in combination 'minor' symptoms of multiple sclerosis

To investigate the clinical and neurophysiological features of sleep disorders in patients with different forms of multiple sclerosis (MS) and their impact on life quality, dynamic and prognosis of the disease. Identify the impact of sleep disorders on the formation and maintenance of chronic fatigue syndrome in patients with MS. General clinical methods of examination like neuropsychological testing (definition of anxiety and depression), the scales of the subjective determination of the quality of sleep, the severity of daytime sleepiness, quality of life, severity of chronic fatigue syndrome) and their subsequent correlation with neuroimaging and neurophysiological data were studied. 54 patients with different forms of MS and 54 healthy volunteers in the control group were selected. Data analysis showed a high level of sleep disorders associated with anxiety disorders, comorbid pathologies, which is significantly higher in the study group.

Consenso para el tratamiento de la esclerosis múltiple 2016. Sociedad Española de Neurología

With the advent of new disease-modifying drugs, the treatment of multiple sclerosis is becoming increasingly complex. Using consensus statements is therefore advisable. The present consensus statement, which was drawn up by the Spanish Society of Neurology's study group for demyelinating diseases, updates previous consensus statements on the disease.The present study lists the medications currently approved for multiple sclerosis and their official indications, and analyses such treatment-related aspects as activity, early treatment, maintenance, follow-up, treatment failure, changes in medication, and special therapeutic situations.This consensus statement includes treatment recommendations for a wide range of demyelinating diseases, from isolated demyelinating syndromes to the different forms of multiple sclerosis, as well as recommendations for initial therapy and changes in drug medication, and additional comments on induction and combined therapy and practical aspects of the use of these drugs.

Gait pattern differences between different forms of multiple sclerosis

Multiple sclerosis (MS) is a chronic inflammatory demyelinating and neurodegenerative disease of the central nervous system. MS can cause different patterns of motor disturbances and gait difficulties in all its main clinical phenotypes: relapsing–remitting (RRMS), secondary-progressive (SPMS) or primary-progressive MS (PPMS). We mesasured gait pattern and characteristics in 54 MS patients, 40 with RRMS and 14 with PPMS. In those two forms we compared effects of dual task paradigm on gait characteristics (motor or mental task performance during gait) and compared gait pattern parameters (gait cycle time, stride length, single and double limb support time, as well as their coefficients of variation). Gait cycle is generally considered as automatically generated rhythmic pattern. However, tasks performed during gait in MS are affecting gait parameters differently. Cycle time is longer and stride length is shorter in RR compared to PP form, while motor and mental tasks are affecting gait parameters of both MS forms in similar manner, increasing their coefficients of variation. Changes in gait parameters and characteristics in RRMS and PPMS forms might be the consequences of different internal and external interactions. Those differences could help to design and separate treatment strategies for different MS forms.

TH17-Driven Inflammation is Present in All Clinical Forms of Multiple Sclerosis; Disease Quiescence is Associated with Gata3-Expressing Cells

Multiple Sclerosis (MS) presents in a variety of clinical forms associated with a diverse grade of neurological impairment, different prognosis and, possibly, multiple pathogenic mechanisms. Thus, whereas relapsing-remitting (RR) MS appears to be largely driven by inflammatory processes, neurodegeneration, partially independent from inflammation, drives primary progressive (PP) and secondary progressive (SP) MS. An extensive analysis of neuroinflammation in the different forms of MS was performed by evaluating immunophenotypic and functional parameters in MBP-stimulated T lymphocytes of 103 MS patients (26 benign (BE) MS, 30 RRMS, 33 SPMS and 14 PPMS) and 40 healthy controls (HC). Results showed that: i) IL-17-producing and RORC/γt-expressing CD4+ T cells (TH17 lymphocytes), as well as IL-6 expressing CD14+ cell were augmented in all patients; ii) IL-22-expressing cells were increased in all forms of MS with the exception of PPMS; iii) TGF-β-expressing B cells were increased only in RRMS; and iv) GATA3-, NFATc-1, IL-13-, and IL-25-expressing cells (TH2 lymphocytes) were augmented in RRMS and BEMS patients alone. Data herein indicate a pivotal pathogenic role of TH17-driven inflammation in all clinical forms of MS and suggest that control over disease (RRMS and BEMS) is associated not with lack of inflammation per se, but rather with the activation of immune-mediated anti-inflammatory mechanisms. These results could help the design of novel diagnostic and therapeutic approaches.

1303 – Depression, anxiety and multiple sclerosis-serbian experience

It is well known that patients with multiple sclerosis (MS) have frequently affective and anxiety spectrum disorders.The aim of our study was to assesss the links between anxious and depressive symptoms on one hand and the quality of life (QOL) and daily activities and abilities on the other, in patients diagnosed with MS. We measured the intensity of depression using HAMD-17 item., and the intensity of anxiety using HAM-A scale. We also measured the expanded disability status scale (EDSS) score for each patient. Our batch was composed of 98 patients diagnosed with different forms of multiple sclerosis. The patients with relapsing remitting MS were free of acute neurological deficits during the examination. For every patient we performed neurological examination (EDSS) and the assessment of depression, of anxiety, of daily activities (activities of daily living-ADL and instrumental activities of daily living-IADL) and of the quality of life-score and grade (QOL score and QOL grade). First we found strong correlations between neurological deficit (measured by EDSS) and HAM-A, HAM-D, ADL, IADL,QOL score and QOL grade (using Pearson method: p= 0.0001 for each. For different levels of EDSS score we tried to correlate HAM-A and HAm-D with ADL, IADL, QOL (score and grade). The correlations were all valid with a stronger connection in the groups with a higher EDSS score. Anxiety and depression levels grow together with the EDSS score. Anxiety and depression spectrums are interrelated by increasing each other;s level regardless of MS severity.

Immunoadsorption in steroid-refractory multiple sclerosis

Multiple sclerosis (MS) is an autoimmune disorder, with involvement of both the humoral and cellular components of the immune system. The use of plasma exchange (PE) in steroid-refractory relapses has become an integral part of national and international guidelines for the treatment of steroid-resistant relapses of MS with an efficacy of 40–70%. So far, 6 studies of immunoadsorption (IA) treatment in different forms of MS have been published, 4 of them in steroid-refractory MS relapses. These 4 studies revealed a significant clinical improvement in 73–85% of patients with steroid-refractory MS relapses. However in MS patients with non-active relapsing–remitting or secondary progressive course, there was no clinical improvement. Despite the limited number of patients and studies, these data suggest a reasonably similar efficacy of IA in the treatment of steroid-refractory MS relapses compared to PE. More prospective trials are needed to confirm and extend these results.

Cognitive analysis of multiple sclerosis utilizing fuzzy cluster means

Multiple sclerosis, often called MS, is a disease that affects the central nervous system (the brain and spinal cord). Myelin provides insulation for nerve cells improves the conduction of impulses along the nerves and is important for maintaining the health of the nerves. In multiple sclerosis, inflammation causes the myelin to disappear. Genetic factors, environmental issues and viral infection may also play a role in developing the disease. Ms is characterized by life threatening symptoms such as; loss of balance, hearing problem and depression. The application of Fuzzy Cluster Means (FCM or Fuzzy CMean) analysis to the diagnosis of different forms of multiple sclerosis is the focal point of this paper. Application of cluster analysis involves a sequence of methodological and analytical decision steps that enhances the quality and meaning of the clusters produced. Uncertainties associated with analysis of multiple sclerosis test data are eliminated by the system

Protein biomarkers for multiple sclerosis: semi-quantitative analysis of cerebrospinal fluid candidate protein biomarkers in different forms of multiple sclerosis

Background: The complex pathogenesis of multiple sclerosis, combined with an unpredictable prognosis, requires identification of disease-specific diagnostic and prognostic biomarkers. Objective: To determine whether inflammatory proteins, such as neurofilament light chain, myelin oligodendrocyte glycoprotein and myelin basic protein, and neurodegenerative proteins, such as tau and glial fibrillary acidic protein, can serve as biomarkers for predicting the clinical subtype and prognosis of MS. Methods: Cerebrospinal fluid and serum samples were collected from patients with a diagnosis of clinically isolated syndrome (n = 46), relapsing–remitting MS (n = 67) or primary-progressive MS (n = 22) along with controls having other non-inflammatory neurological disease (n = 22). Western blot analyses were performed for the listed proteins. Protein levels were compared among different clinical subtypes using one-way analysis of variance analysis. The k-nearest neighbour algorithm was further used to assess the predictive use of these proteins for clinical subtype classification. Results: The results showed that each of tau, GFAP, MOG and NFL protein concentrations differed significantly (p < 0.001) in multiple sclerosis clinical subtypes compared with the controls. Levels of the proteins also differed between the multiple sclerosis clinical subtypes, which may be associated with the underlying disease process. Classification studies revealed that these proteins might be useful for identifying multiple sclerosis clinical subtypes. Conclusions: We showed that select biomarkers may have potential in identifying multiple sclerosis clinical subtypes. We also showed that the predictive value of the prognosis increased when using a combination of the proteins versus using them individually.

Long-term follow-up of clinical trials of multiple sclerosis therapies

Results from registry studies can provide valuable information about the prevalence and clinical course of different forms of multiple sclerosis (MS). Such studies can also help identify medical practice patterns in a real-world setting and important risk factors that may affect long-term outcomes in patients with MS. To date, however, these observational studies have provided less information than well-planned, randomized, controlled trials on the long-term treatment effects of disease-modifying therapies (DMTs). Short-term clinical trial results have indicated that currently available DMTs are effective in reducing disease activity, manifested by relapse or MRI change, and may slow disease progression. Because MS is a chronic disease that evolves over a period of 30 to 40 years, determining the long-term effects of treatment is of critical importance to both patients and providers. This article discusses long-term studies of DMTs in patients with MS. Exploratory data provided thus far support the hypothesis that early optimal treatment aimed at reducing disease activity can improve longer-term outcomes by delaying disease progression.