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

  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},
Review: Escalating immunotherapy of multiple sclerosis
Potential candidates for intensified immunosuppression are reviewed and innovative study designs are called for to better evaluate escalating immunotherapy in MS.
Disease-Modifying Agents for Multiple Sclerosis
The concept of neuro-protection and -regeneration has not advanced to a level where specific compounds have entered clinical testing, however, several agents approved for conditions other than MS are highlighted.
Therapeutic decision making in a new drug era in multiple sclerosis.
It remains essential to make an unequivocal diagnosis of MS and identify its clinical course prior to initiating therapies, and switching and altering MS therapies can now be done by rational approaches based on therapeutic efficacy and tolerability; however, these remain nonevidence-based for the most part.
Lights and Shadows of Cyclophosphamide in the Treatment of Multiple Sclerosis
Cyclophosphamide (cy) is an alkylating agent used to treat malignancies and immune-mediated inflammatory nonmalignant processes. It has been used as a treatment in cases of worsening multiple
Mechanism of multiple sclerosis based on the clinical trial results of molecular targeted therapy
Clinical trial results of molecular targeted therapy that shed light on the improving understanding of the immunopathogenesis of MS are discussed in the present review.
Therapy of multiple sclerosis in children and adolescents
  • S. Tenembaum
  • Medicine, Psychology
    Clinical Neurology and Neurosurgery
  • 2010
Immunosuppression in clinical practice
Practical aspects in the clinical use of immunosuppressants in MS are reviewed and approaches to individualized treatment schemes, including novel pharmacogenetic strategies are discussed.
Fumarates for the treatment of multiple sclerosis: potential mechanisms of action and clinical studies
FAE are potential candidates that may open a new therapeutic option for relapsing–remitting MS in the near future and are already in clinical use for the systemic treatment of severe psoriasis.
Immunomodulatory Therapies in Neurologic Critical Care
There is good evidence for the efficacy and tolerability of immunomodulatory therapies in GBS, myasthenia gravis, and acute central nervous system demyelination, though data to establish superiority of one therapeutic regimen over another remains lacking.
Risk-benefit considerations in the treatment of relapsing-remitting multiple sclerosis
A comprehensive overview of the main present and some future drugs for relapsing-remitting MS, including risk-benefit considerations, is given to enable readers to draw their own conclusions regarding the risk- benefit assessment of personalized treatment strategies, taking into account not only treatment-related but also disease-related risks.


Immunosuppressive treatment in multiple sclerosis
  • H. Weiner
  • Biology, Medicine
    Journal of the Neurological Sciences
  • 2004
Current treatment options in multiple sclerosis
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
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
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.
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
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.
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.
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.