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Use of Disease-Modifying Therapies in Multiple Sclerosis

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Neuroimmunology

Abstract

Drug development over the last 30 years has resulted in the regulatory approval of over 20 disease-modifying therapies (DMTs) for multiple sclerosis (MS) in the United States, including multiple DMTs in the same class (interferons, fumarates, and sphingosine-1-phosphate modulators), multiple generics (two generic versions of glatiramer acetate, three generic versions of fingolimod), and several other drugs that are used off-label (rituximab, mycophenolate mofetil, others). The first DMT has now been approved for pediatric use (fingolimod), and DMTs have been or are being tested in nearly all phases and phenotypes of the illness, including even those who have not yet had clinical symptoms suggestive of MS, but whose magnetic resonance images (MRIs) are consistent with MS—radiologically isolated syndrome (RIS).

Given that patients may remain on a DMT for many years, their annual and cumulative costs are high, and potential risks of DMT use may be significant; maximum diagnostic certainty is extremely important. At the same time, however, evidence has accumulated that earliest possible treatment results in better outcomes. Along with unavailability of a reliable biomarker that convincingly separates those with relatively benign or severe prognoses at the earliest stages of the disease, this tension between early treatment and diagnostic certainty has helped fuel inconsistent approaches in the early use of DMTs in MS. MRI markers such as the central vessel sign and biomarkers such as neurofilament light appear promising regarding enhancing diagnostic and perhaps prognostic certainty.

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  1. Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, USA

    John R. Corboy & Robert H. Gross

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  1. University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Amanda L. Piquet

  2. University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Enrique Alvarez

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Corboy, J.R., Gross, R.H. (2021). Use of Disease-Modifying Therapies in Multiple Sclerosis. In: Piquet, A.L., Alvarez, E. (eds) Neuroimmunology. Springer, Cham. https://doi.org/10.1007/978-3-030-61883-4_31

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