Multiple Sclerosis Conclusion
There are currently seven FDA-approved disease-modifying therapies for relapsing forms of MS. Good level I evidence exists for all these compounds. Natalizumab and novantrone are effective medications but their use may be limited by their adverse effect profile, which includes potentially lethal conditions. Fampridine is an oral medication that improves walking speed in various types of MS and is FDA-approved for that use. Medications that appear to be close to FDA approval after large phase III trials include cladribine and fingolimod. The potential adverse effects of these medications will be weighed against their benefit and ease of use (both are oral medications).
There are currently multiple medications under phase II–III testing that may bring further options for treatment in the future. Treatment of MS in the near future will include multiple agents with diverse mechanisms of action, and clinicians will need to know how to treat and identify the adverse events that result from these agents. n
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Alex Rae-Grant, MD, FRCP(C), is a Neurologist at the Mellen Center for Multiple Sclerosis (MS) and the Neurological Institute at the Cleveland Clinic. His area of expertise is in MS and related diseases. He is also involved in educational activities at the Cleveland Clinic and regionally, and participates in many clinical trials in MS. Dr Rae-Grant has written two textbooks: Neurology for the House Officer and The Five-minute Consult in Neurology.
Daniel Ontaneda, MD, is a Neurology Resident at the Mellen Center for Multiple Sclerosis (MS) and the Neurological Institute at the Cleveland Clinic, where he is completing his fourth year of post-graduate training. He will be completing a three-year clinical neuro-immunology fellowship at the Mellen Center for MS in conjunction with an MSc in clinical research at Case Western Reserve University. Dr Ontaneda graduated from the Pontifical Catholic University and completed a post-doctoral fellowship at Baylor College of Medicine.
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