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Management and Care – The Changing Landscape of Multiple Sclerosis
A retrospective double-blind analysis of the MRI data collected from shown that patients benefited in terms of reductions in the mean number
the first year of the two-year phase II clinical trial of MN-166 (ibudilast, of T1 lesions when switching to laquinimod from placebo, although no
MediciNova Inc.) in relapsing MS patients has suggested the drug’s significant difference in annualised relapse rate could be discerned.
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ability to protect neurons from persistent damage following the
formation of acute lesions, preventing conversion to persistent black Summary
holes; the presenters noted that further studies regarding black hole The revelations in MS at the 18th meeting of the ENS have shown a
formation and disease progression in patients with relapsing or great deal of evidence arguing in support of early treatment,
progressive MS are warranted.
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The CD52-specific monoclonal endeavouring to protect patients against disease progression and
antibody alemtuzumab (Bayer/Genzyme), which targets lymphocytes, further deterioration of the CNS. Recent research suggests an increase
has been compared with high-dose interferon beta-1a (Rebif) in the in the prevalence of the disease, which makes it all the more important
phase II CAMMS223 study treating patients with RRMS. The study to establish an optimal therapy. Many recommendations and even
showed that at the three-year follow-up the antibody was more more options exist as to selecting a drug for a patient, and many
effective at suppressing relapses and disability in patients than the factors must be considered before choosing to start a patient on any
interferon, with patients in the former group experiencing a 73% given treatment. Experts in the field have placed heavy emphasis on
reduction in risk of relapse (p<0.0001) and a 70% reduction in risk of the benefits of early treatment, when patients can experience greater
sustained accumulation of disability (p<0.0001).
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Subgroup analyses drug efficacy than at any other phase of the disease course. Many
found the treatment effects of alemtuzumab to be consistent across recent drug trials have demonstrated a move towards greater safety
sex, age, race and country, indicating that these findings were and tolerability, while maintaining a high level of efficacy. Therapies
independent of patient baseline demographics. are only as effective as the adherence, and programmes providing
personal assistance and monitoring have proved successful in
Some of these drugs being developed and studied are oral compounds – upholding a high level of adherence among patients. Many new drugs
a class of MS therapies that is amassing increasing interest from are in development as well; of these, there is great anticipation for the
researchers and physicians alike. One example of these new oral drugs is oral therapies being tested, where it is hoped that the advantage of
laquinimod (Teva Pharmaceutical); MRI data from an extension of the convenience over the current parenteral options will also help to
double-blind, randomised, placebo-controlled phase IIb study have maintain good adherence levels. ■
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EUROPEAN NEUROLOGICAL REVIEW 85
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