INTRODUCTION
With the development of effective therapies for multiple sclerosis (MS), therapeutic nihilism, which was so prevalent just 10 years ago, has given way to exuberance and optimism. The current mood is understandable because MS is such a devastating disease. Within 10 years of symptom onset, 50% of patients with MS are unable to carry out household and employment responsibilities; within 15 to 20 years, 50% are unable to walk unassisted; and within 25 years, 50% are unable to walk at all. The average annual cost of MS in the United States has been estimated at greater than $6.8 billion, or $34,103 per person.1 This review summarizes evidence that disease-modifying drugs can significantly improve the course of patients with relapsing-remitting MS (RRMS) and frames key issues relating to the use of current drugs. Major issues confronting experimental MS therapeutics are discussed.
DRUGS FOR RRMS
Recombinant interferon beta-1b (IFN-
-1b) (Betaseron; . . . [Full Text of this Article]
CONTEMPORARY ISSUES ABOUT APPROVED MS DRUGS
Which of the Available Drugs Is Most Efficacious?
When Should Therapy Be Initiated, and What Is the Optimal Duration of Therapy?
Should a Patient Receiving One of the Current Drug Therapies Be Evaluated With Periodic MRI Scans?
Should Patients Receiving IFN- Therapy Routinely Have Tests for Neutralizing Antibodies?
Should Patients With SPMS Be Treated With Available Drugs?
What Are the Long-term Benefits and Risks of Current MS Drug Therapies, and Do the Long-term Benefits Justify the Cost of the Drugs?
THE FUTURE OF CONTROLLED CLINICAL TRIALS FOR MS THERAPY
Are Placebo-Controlled Trials Justified?
Can We Improve Clinical Outcome Measures for Future Trials?
What Is the Relative Role of MRI Compared With Clinical Measures in MS Therapy Trials?
Can We Design Methods to Reliably Test MS Drug Therapies in Combination?
Can Therapeutic Interventions Be Rationally Designed to Target Specific Pathogenic Mechanisms?
