Secondary progressive multiple sclerosis: current knowledge and future challenges

@article{Rovaris2006SecondaryPM,
  title={Secondary progressive multiple sclerosis: current knowledge and future challenges},
  author={Marco Rovaris and Christian Confavreux and Roberto Furlan and Ludwig Kappos and Giancarlo Comi and Massimo Filippi},
  journal={The Lancet Neurology},
  year={2006},
  volume={5},
  pages={343-354}
}
The secondary progressive phase of multiple sclerosis (MS), which is characterised by a steady accrual of fixed disability after an initial relapsing remitting course, is not clearly understood. Although there is no consensus on the mechanisms underlying such a transition to the progressive phase, epidemiological and neuroimaging studies indicate that it is probably driven by the high prevalence of neurodegenerative compared with inflammatory pathological changes. This notion is lent support by… 
View on Elsevier
doi.org
256 Citations
Highly Influential Citations
9
Background Citations
100
Methods Citations
1
Results Citations
9

256 Citations

Citation Type

Citation Type

MULTIPLE SCLEROSIS: THERAPEUTIC FRONTIERS AND PROGRESSIVE DISEASE *
TLDR
The diagnostic and therapeutic challenges presented by PPMS and SPMS are reviewed; then it will turn to a discussion of the latest treatment interventions being tested in clinical trials.
Pharmacological Approaches to the Management of Secondary Progressive Multiple Sclerosis
TLDR
The optimal strategy to target secondary progressive MS (SPMS), where relapses occur before the onset of gradual, irreversible disability, is to utilise the prodrome of relapses to initiate a therapy that will aim to both prevent progression and slow its accumulation.
Secondary Progressive Multiple Sclerosis: What is in the
TLDR
If progression follows an initial relapsing-remitting course, this is referred to as SPMS and disease progression is defined as continuous worsening of neurological status over at least 6 or 12 months.
Secondary Progressive Multiple Sclerosis: Definition and Measurement
TLDR
The definition(s) of SPMS is discussed and how it may vary, outcome measurements (current and emerging) and modern trial design are discussed, and the vast majority of clinical trials testing immunosuppressant and immunomodulating drugs in SPMS patients has so far yielded disappointing or mixed results.
Treatment trials in progressive MS—current challenges and future directions
TLDR
The current approach to clinical trial design in progressive MS is reviewed, key ongoing challenges are outlined, and strategies to overcome such hurdles are suggested.
Progressive multiple sclerosis: from pathogenic mechanisms to treatment.
TLDR
Mechanisms involved in progressive multiple sclerosis, correlations between histopathology and magnetic resonance imaging studies, along with possible new therapeutic approaches are discussed.
Secondary progressive multiple sclerosis - from neuropathology to definition and effective treatment.
TLDR
The need to establish criteria for the diagnosis of SPMS is currently of crucial importance due to emerging treatment opportunities including siponimod, a sphingosine 1-phosphate (S1P) receptor modulator selective for S1P1 and S 1P5 receptors.
The natural history of secondary progressive multiple sclerosis
TLDR
Three factors influencing the onset of SPMS in untreated patients with RRMS in British Columbia were identified: motor onset symptoms and male gender were associated with both a shorter time to and a younger age at SPMS, while a newer age at disease onset should not be viewed as indicating a better prognosis.
Natural history comparisons of primary and secondary progressive multiple sclerosis reveals differences and similarities
TLDR
Although there were some similarities between SPMS and PPMS, the former had a later onset age in the British Columbian MS cohort, such that the baseline characteristics, including age at progression, may shift.
Approaches and challenges in the diagnosis and management of secondary progressive multiple sclerosis: A Central Eastern European perspective from healthcare professionals.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 148 REFERENCES
The natural history of multiple sclerosis
The course of multiple sclerosis (MS) results from the interplay of two clinical processes, relapses and progression. Three main clinical forms may be identified as relapsing-remitting, secondary…
Course and prognosis of chronic progressive multiple sclerosis: Results of an epidemiological study
TLDR
Determining the “year of progression” seems to be significant for the prognosis of multiple sclerosis, and progression of the handicap was most rapid in case of a secondary progressive course, female sex, high relapse rate in the preceding remitting phase and “ year ofgression” at a higher age.
Primary and secondary progressive multiple sclerosis
TLDR
The clinical similarities and differences between secondary and primary progressive MS are discussed, including the comparison between the different MS subtypes with a progressive phase.
Long-term follow up of patients with clinically isolated syndromes, relapsing-remitting and secondary progressive multiple sclerosis
TLDR
Predictors from this study could be used to refine historically controlled trials, and early predictors were unable to predict the rate of progression, which seems to contain an element of the disease process unassociated with its early events.
Prognostic factors for progression of disability in the secondary progressive phase of multiple sclerosis
TLDR
Information available from the literature and from the Lyon MS database about the secondary progressive phase is reviewed, which is the one most often associated with the development of severe and irreversible disability.
The window of therapeutic opportunity in multiple sclerosis
TLDR
It is speculated that the beneficial effects of early rescue of neurons and axons from a toxic inflammatory environment, and that prevention of demyelination will prevent long–term axonal degeneration, are currently being tested in a controlled trial comparing Campath–1H and IFN–beta in the treatment of drug–naïve patients with early, active RR MS.
Secondary progressive multiple sclerosis: the relationship between short-term MRI activity and clinical features.
TLDR
It is concluded that short-term MRI activity is generally high in secondary progressive disease, confirming a useful role for the technique in exploratory trials and elucidating the mechanisms of secondary progression by longer term follow-up studies of larger cohorts using multiple MRI and clinical measurements.
A comparison of the pathology of primary and secondary progressive multiple sclerosis.
TLDR
There was significantly more inflammation in secondarygressive multiple sclerosis (as judged by the frequency of perivascular cuffing and cellularity of the parenchyma) than in primary progressive disease, which has implications for therapeutic strategies in progressive multiple sclerosis.
Primary and transitional progressive MS
TLDR
The monitoring of disease progression in PPMS is difficult, although measures of atrophy correlate with the EDSS and appear most promising, which increases the understanding of this unique patient group, which will be further expanded with the acquisition of serial data.
Primary progressive multiple sclerosis.
TLDR
The mechanisms underlying the development of disability and the role of MRI in monitoring disease activity in this clinical subgroup require elucidation, particularly in view of the lack of change on conventional imaging in the presence of continuing clinical deterioration.
...
1
2
3
4
5
...