Intense immunosuppression in patients with rapidly worsening multiple sclerosis: treatment guidelines for the clinician

@article{Boster2008IntenseII,
  title={Intense immunosuppression in patients with rapidly worsening multiple sclerosis: treatment guidelines for the clinician},
  author={Aaron Boster and Gilles Edan and Elliot M. Frohman and Adil Javed and Olaf Stuve and Alex C. Tselis and Howard L. Weiner and Bianca Weinstock-Guttman and Omar A. Khan},
  journal={The Lancet Neurology},
  year={2008},
  volume={7},
  pages={173-183}
}
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TLDR
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References

SHOWING 1-10 OF 115 REFERENCES
Immunosuppressive treatment in multiple sclerosis
  • H. Weiner
  • Biology, Medicine
    Journal of the Neurological Sciences
  • 2004
Current treatment options in multiple sclerosis
TLDR
Early treatment with disease-modifying therapy should be considered in patients with first episode of demyelination and presence of MRI lesions consistent with MS, and natalizumab and mitoxantrone significantly decrease relapses and MRI lesions in Patients with relapsing MS.
Stabilization of rapidly worsening multiple sclerosis for 36 months in patients treated with interferon beta plus cyclophosphamide followed by interferon beta
TLDR
Encouraging findings and the absence of significant recorded side effects affirm that the association of CTX plus interferon-beta is amenable, safe and can be recommended in rapidly worsening MS patients.
The safety profile of cyclophosphamide in multiple sclerosis therapy
TLDR
Data from the literature suggest that Cyc is particularly indicated in the treatment of young MS patients, suffering from a very active inflammatory disease characterised by frequent relapses and rapid accumulation of disability and displaying gadolinium-enhancing lesions on brain magnetic resonance.
Cyclophosphamide therapy for MS.
TLDR
Toxic effects on the bladder and the risk of malignancy prevent the widespread use of cyclophosphamide in early MS; however, it can be dosed safely and is usually well tolerated in actively progressing relapsing-remitting or early secondary progressive MS cases that are unresponsive to beta interferon and glatiramer acetate.
Treatment of progressive multiple sclerosis with pulse cyclophosphamidel methylprednisolone: Response to therapy is linked to the duration of progressive disease
TLDR
The data suggest that progressive MS may become refractory to immunosuppressive therapy with time and early intervention when patient enter the progressive stage should be considered.
Cyclophosphamide for multiple sclerosis.
TLDR
Intensive immunosuppression with CFX in patients with progressive MS compared to placebo or no-treatment did not prevent the long-term risk to evolution to a next step of EDSS, but less toxic schedules must be considered before its use in the clinical practice.
TREATMENT OF FULMINANT MULTIPLE SCLEROSIS WITH INTRAVENOUS CYCLOPHOSPHAMIDE
TLDR
This consecutive case series suggests that CTX/MP represents an effective therapeutic option for those rare MS patients with a fulminant progressive course who are refractory to corticosteroid therapy.
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