Since the last decade of the twentieth century, research in multiple sclerosis has grown exponentially, which has led to the introduction of various treatments that have contributed to modify the evolutionary course of the disease, although a cure has not yet been found.
Early treatments of multiple sclerosis
In the 1950s, corticotropin (ACTH) began to be used subcutaneously. This drug improved the symptoms and the duration of the episodes, a fact that would be demonstrated years later in a controlled study with a placebo group. A similar effect is achieved by methylprednisolone, administered at high doses and intravenously, and this is the most commonly used drug to treat MS episodes.
The use of Azathioprine, methotrexate and cyclophosphamide, in different doses and used in different levels of illness severity, have been reported empirically since the 1980s, taking into account the autoimmune hypothesis as the cause of MS. In 1993, interferon beta 1b began to be used subcutaneously (Betaferon), after demonstrating a disease-modifying effect by significantly reducing the rate of outbreaks compared to a placebo in a double-blind, controlled study.
Changes to the development of treatments
The demonstration of therapeutic effectiveness, following the rules of evidence-based medicine, has since been demanded of all drugs approved by regulatory agencies. Subsequently, three years later, interferon beta 1a (Avonex) was introduced intramuscularly. In 1997, Glatiramer acetate (Copaxone) was made available and in 1998, interferon beta 1a was available for subcutaneous use in high dosage (Rebif). All these so-called immunomodulators are currently considered very safe and relatively effective.
Mitoxantrone was introduced in Neurology in 2000 to treat aggressive forms of MS, but its serious side effects (heart disease and leukaemia), coupled with the approval in 2006 of natalizumab (Tysabri) means it is currently hardly used.
In 2011, fingolimod (Gylenia), an oral drug, was approved. The drug was considered to be a selective immunosuppressants, that interferes with the passage into the CNS of activated T lymphocytes.
Latest developments in treatments for multiple sclerosis
In the last two years, two new oral immunomodulatory drugs, teriflunomide (Aubagio) and dimethylfumarate (Tecfidera), and a new monoclonal antibody, alentuzumab (Lemtrada), have been approved. The first two are at least similar or superior to the first line drugs (interferons and coaxaxone).
This high-efficacy drug can produce various immunological effects (thyroiditis, thrombocytopenia, glomerulonephritis) which require constant monitoring in spite of their spaced administration.
In addition to drugs administered to modify the course of the disease, others are used to treat the associated symptoms: paroxysmal symptoms (carbamazepine and gabapentin), fatigue (amantadine and modafinil), spasticity (botulinum toxin, diazepam, tizanidine, baclofen and cannabidiol), gait claudication (fampridine).