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Concepts of induction and escalation therapy in multiple sclerosis.
J Neurol Sci 2009; 277 Suppl 1:S42-5JN

Abstract

Current treatment options for first-line immunotherapy in relapsing remitting multiple sclerosis are recombinant interferon-beta and glatiramer acetate. However, these therapies are only partially effective and certain patients may fail to respond. For this reason, it is important to elaborate alternative treatment strategies. Induction or escalation strategies have demonstrated their worth in other autoimmune disorders and may also prove to be beneficial in multiple sclerosis. The current concept of escalation therapy involves switching patients who fail first-line therapy to either natalizumab or mitoxantrone, although neither of these agents has been evaluated rigorously in such patient groups. Standardised algorithms are required to monitor treatment outcome, to determine treatment failure and to structure proceeding from one level of therapy to another. In patients with severe disease activity at onset who are at risk for early accumulation of disability, induction therapy with a powerful immunosuppressant followed by maintenance therapy with glatiramer acetate or interferon-beta may be considered. Encouraging findings in this direction have been obtained for immunosuppression with alemtuzumab or mitoxantrone. In all cases, treatment decisions should be tailored to the needs and status of the individual patient and taken pragmatically after informed discussion with the patient.

Authors+Show Affiliations

Department of Medicine, University of British Columbia, Vancouver, Canada. prieckmann@brain.ubc.ca

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19200866

Citation

Rieckmann, Peter. "Concepts of Induction and Escalation Therapy in Multiple Sclerosis." Journal of the Neurological Sciences, vol. 277 Suppl 1, 2009, pp. S42-5.
Rieckmann P. Concepts of induction and escalation therapy in multiple sclerosis. J Neurol Sci. 2009;277 Suppl 1:S42-5.
Rieckmann, P. (2009). Concepts of induction and escalation therapy in multiple sclerosis. Journal of the Neurological Sciences, 277 Suppl 1, pp. S42-5. doi:10.1016/S0022-510X(09)70012-7.
Rieckmann P. Concepts of Induction and Escalation Therapy in Multiple Sclerosis. J Neurol Sci. 2009 Feb 1;277 Suppl 1:S42-5. PubMed PMID: 19200866.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concepts of induction and escalation therapy in multiple sclerosis. A1 - Rieckmann,Peter, PY - 2009/2/10/entrez PY - 2009/2/10/pubmed PY - 2009/7/8/medline SP - S42 EP - 5 JF - Journal of the neurological sciences JO - J. Neurol. Sci. VL - 277 Suppl 1 N2 - Current treatment options for first-line immunotherapy in relapsing remitting multiple sclerosis are recombinant interferon-beta and glatiramer acetate. However, these therapies are only partially effective and certain patients may fail to respond. For this reason, it is important to elaborate alternative treatment strategies. Induction or escalation strategies have demonstrated their worth in other autoimmune disorders and may also prove to be beneficial in multiple sclerosis. The current concept of escalation therapy involves switching patients who fail first-line therapy to either natalizumab or mitoxantrone, although neither of these agents has been evaluated rigorously in such patient groups. Standardised algorithms are required to monitor treatment outcome, to determine treatment failure and to structure proceeding from one level of therapy to another. In patients with severe disease activity at onset who are at risk for early accumulation of disability, induction therapy with a powerful immunosuppressant followed by maintenance therapy with glatiramer acetate or interferon-beta may be considered. Encouraging findings in this direction have been obtained for immunosuppression with alemtuzumab or mitoxantrone. In all cases, treatment decisions should be tailored to the needs and status of the individual patient and taken pragmatically after informed discussion with the patient. SN - 0022-510X UR - https://www.unboundmedicine.com/medline/citation/19200866/Concepts_of_induction_and_escalation_therapy_in_multiple_sclerosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-510X(09)70012-7 DB - PRIME DP - Unbound Medicine ER -