Disease-modifying therapies in relapsing–remitting multiple sclerosis

Fabricio González-Andrade¹, José Luis Alcaraz-Alvarez²

¹Department of Medicine, Metropolitan Hospital, Quito, Ecuador; ²School of Medicine, University of Mayab, Merida, Mexico

Clinical question: What is the best current disease-modifying therapy for relapsing–remitting multiple sclerosis?

Results: The evidence shows that the most effective disease-modifying therapy for delaying short- to medium-term disability progression, prevention of relapses, reducing the area and activity of lesions on magnetic resonance imaging, with the least side effects, is high-dose, high-frequency subcutaneous interferon-β1a 44 μg three times per week.

Implementation: The pitfalls in treatment of MS can be avoided by remembering the following points:

• The most effective therapy to prevent or delay the appearance of permanent neurological disability with the fewest side effects should be chosen, and treatment should not be delayed.

• Adherence to treatment should be monitored closely, and needs comprehensive patient information and education to establish long-term adherence, which is a critical determinant of long-term outcome.

• The correct approach to the disease includes disease management, symptom management, and patient management. A combination of tools is necessary to ease the various symptoms, which fall into three broad categories, i.e. rehabilitation, pharmacological, and procedural.

• It is important to understand that no treatment modality should be used alone, unless it is in itself sufficient to remedy the particular symptom/problem.

Keywords: relapsing–remitting multiple sclerosis, interferon, disease-modifying therapy, relapse prevention