Trials of Licenced RRMS DMTs in Progressive MS

Chapter

Abstract

The success of the phase III randomized controlled trials (RCTs) of disease-modifying therapies (DMTs) in relapsing–remitting multiple sclerosis (RRMS) [1–4] naturally led to exploration of their efficacy in both secondary progressive multiple sclerosis (SPMS) and primary progressive multiple sclerosis (PPMS). This chapter deals with trials of “conventional” disease-modifying therapies (DMTs), by which we mean drugs which are recognised as having therapeutic utility in the treatment of relapsing-remitting multiple sclerosis. These drugs are almost exclusively immunomodulatory, with particular emphasis on restricting the effector functions of T and B cells. Therefore as well as clinical benefit, these clinical trials help identify which pathways drive the poorly understood substrate of disease progression in humans. The bottom line is that almost all of these trials have been unsuccessful at meeting their primary endpoint in a clinically meaningful way. However, much has been learned about trial design and progress towards modest therapeutic activity has been made [5]. The contrast of therapeutic success of these DMTs in RRMS and their failure in progressive forms of disease is a valuable observation in itself. It suggests that transformative therapies in treatment of the progressive MS are unlikely to come from targeting the largely lymphocyte-driven inflammatory process which occurs early in the disease.

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.St. Vincent’s University HospitalUniversity College DublinDublinIreland
  2. 2.MRC Institute of Genetics and Molecular Medicine, Anne Rowling ClinicUniversity of EdinburghEdinburghUK

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