Rationale and experience with combination therapies in multiple sclerosis
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Standard immunomodulatory therapies for multiple sclerosis reduce relapses by around thirty percent and possibly slow progression of disability. In many patients, use of such treatments allows the disease process to be stabilised and quality of life to be improved. However in patients experiencing frequent severe relapses, for whom prognosis is often poor, they may not be sufficiently efficacious. Emerging therapies such as natalizumab, alemtuzumab or mitoxantrone may be more effective in such patients but have potentially greater side-effects that limit their use as maintenance therapies. Combining current immunomodulatory treatments with emerging therapies may offer the potential to treat patients with active disease successfully and safely. In particular, the use of induction therapy with mitoxantrone followed by maintenance treatment with glatiramer acetate appears to be of interest. In a cohort of over 60 patients receiving this combination in routine clinical practice, disease activity as measured by relapses is rapidly suppressed and the benefit sustained for over five years. With current, anti-inflammatory, therapies decisions on switching and combining therapies need to be made early in the disease course in order to optimise benefit for patients and minimise the risk of accumulating irreversible disability.
Key wordsmultiple sclerosis combination therapy beta-interferon glatiramer acetate mitoxantrone
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