The condition is relatively common, with an estimated 85,000 people in the UK currently diagnosed with MS. It usually affects young adults, with onset often in the 30s, although it can occur in younger people and children, and affects about three times as many women as men (1).
Type of Multiple Sclerosis
There are four main sub-types of multiple sclerosis: primary progressive; secondary progressive; progressive-relapsing; and relapsing-remitting. About 85-90% of patients are diagnosed with relapsing-remitting multiple sclerosis (RRMS) (2). characterized by unpredictable relapses followed by periods of remission that can last months or even years.
Relapses generally contribute to disease progression by resulting in increasing disability, although not all relapses in RRMS result in permanent deterioration. This provides an argument for early treatment of RRMS to reduce the risk of relapses, and therefore reduce the rate of progression.
But is early treatment realistic, and moreover, is it an effective strategy?
Treatments for Multiple Sclerosis
The management of acute relapses with high doses of intravenous corticosteroids aims to reduce the duration of an attack and leave fewer lasting effects. However, this approach doesn’t reduce the number of relapses a patient may suffer, and some deterioration can be expected after many of these attacks (3).
A number of disease modifying therapies are available that aim to reduce the frequency of relapses, therefore reducing the rate of progression in patients with RRMS. The earliest clinical presentation of RRMS is the clinically isolated syndrome (CIS), although not all criteria for MS are fulfilled, and the patient may not be considered for MS treatment at this stage. Although 30-70% of patients with CIS go on to develop RRMS (4), studies have shown that treatment with interferons or glatiramer acetate reduces the chance of developing the condition (5,6).
Disease Modifying Treatments (DMTs) differ in how they are taken, how often they are taken, how effective they are, and also in their toxicity, meaning that the drug that may be considered the most effective may also the most toxic, and cannot be taken for long durations. The decision on which of these drugs to take is therefore a personal one, dependent on what compromises an individual is prepared to make for what gain.
The prognosis of patients with RRMS is dependent on a number of factors. While most patients reach their seventies, most will eventually lose the ability to walk and die of causes directly associated with their MS. The frequency of relapses and the extent of disability are significant, with fewer relapses being associated with greater life expectancy; therefore any course of therapy that reduces the frequency of relapses is likely to prolong patients' duration and quality of life.
Further studies are currently underway to investigate the effectiveness of DMTs and their viability and safety for long term use.
References
- MS Society.About MS.
- Goodin DS et al. Disease modifying therapies in multiple sclerosis. Neurology 2002.
- MS Society. Essentials 01: Managing relapses. MS
- Miller D et al. Clinically isolated syndromes suggestive of multiple sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis. Lancet Neurol 2005; 4(5):281-288.
- Freedman MS et al. Impact of early interferon-beta 1b treatment on disease evolution over 5 years in patients with a first event suggestive of multiple sclerosis. Multiple Sclerosis 2008; 14:S295-S298. Abstract P901.
- Comi G et al. Treatment with Glatiramer acetate delays conversion to clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndrome (CIS): a subgroup analysis. Multiple Sclerosis 2008; 14:S29-S293. Abstract P32.
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