 |
|
Therapeutic Considerations for Disease Progression in Multiple Sclerosis
Evidence, Experience, and Future Expectations
Elliot M. Frohman, MD, PhD;
Olaf Stüve, MD, PhD;
Eva Havrdova, MD;
John Corboy, MD;
Anat Achiron, MD, PhD;
Robert Zivadinov, MD, PhD;
Per Soelberg Sorensen, MD;
J. Theodore Phillips, MD, PhD;
Brian Weinshenker, MD;
Kathleen Hawker, MD;
Hans-Peter Hartung, MD, PhD;
Lawrence Steinman, MD;
Scott Zamvil, MD, PhD;
Bruce A. C. Cree, MD, PhD;
Stephen Hauser, MD;
Howard Weiner, MD;
Michael K. Racke, MD;
Massimo Filippi, MD
Arch Neurol. 2005;62:1519-1530.
In the management of patients with multiple sclerosis (MS), providers are all faced with the highly formidable challenge of ascertaining whether, and to what degree, disease-modifying therapy is effective in the individual patient. While much has been learned in randomized, controlled clinical trials, we cannot simply extrapolate the outcomes of these initiatives and apply them to the care of a single patient. In the future, the application of pharmacogenetic techniques, proteomics, and microarray analysis will yield novel profiling information on individual patients that will substantially refine the specific therapeutic questions of relevance: (1) What is the best treatment for an individual patient? (2) Which patients require intensive therapeutic combination regimens to optimize control of the disease process? (3) What are the appropriate drug dosing targets for an individual patient? and (4) Which patients will be predisposed to the development of drug-related adverse events? Such data may provide a novel variable of drug responsiveness that will mandate its inclusion into the process of covariate analyses for clinical trials.
Author Affiliations: Departments of Ophthalmology (Dr Frohman) and Neurology (Drs Frohman, Stüve, Hawker, and Racke) and Center for Immunology (Dr Racke), University of Texas Southwestern Medical Center, Dallas; Department of Neurology, Heinrich Heine University, Düsseldorf, Germany (Drs Stüve and Hartung); Department of Neurology, Charles University, Prague, Czech Republic (Dr Havrdova); Department of Neurology, University of Colorado, Denver (Dr Corboy); Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel (Dr Achiron); Department of Neurology, University of Buffalo, NY (Dr Zivadinov); Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark (Dr Sorensen); Texas Neurology, Dallas (Dr Phillips); Department of Neurology, Mayo Clinic, Rochester, Minn (Dr Weinshenker); Department of Neurology, Stanford University, Stanford, Calif (Dr Steinman); Department of Neurology, University of California, San Francisco (Drs Zamvil, Cree, and Hauser); Department of Neurology, Brigham and Women’s Hospital, Boston, Mass (Dr Weiner); and Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Milan, Italy (Dr Filippi).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Large-scale, multicentre, quantitative MRI study of brain and cord damage in primary progressive multiple sclerosis
Rovaris et al.
Mult Scler 2008;14:455-464.
ABSTRACT
Modeling Uhthoff's phenomenon in MS patients with internuclear ophthalmoparesis
Davis et al.
Neurology 2008;70:1098-1106.
ABSTRACT
| FULL TEXT
Magnetization transfer MRI metrics predict the accumulation of disability 8 years later in patients with multiple sclerosis
Agosta et al.
Brain 2006;129:2620-2627.
ABSTRACT
| FULL TEXT
Insights Into the Molecular Pathogenesis of Progression in Multiple Sclerosis: Potential Implications for Future Therapies
Imitola et al.
Arch Neurol 2006;63:25-33.
ABSTRACT
| FULL TEXT
|
