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The past decade has witnessed significant advances in the understanding of the
pathophysiology of MS and in the development of novel disease-modifying agents
(DMA). The use of DMA in the treatment of patients with MS has drastically
increased not only in the United States but throughout the rest of the world.
Currently, in the United States, most patients given a diagnosis of relapsing-remitting
MS are commenced on a DMA. Controversy still exists regarding how early
DMA should be commenced and whether all patients with relapsing-remitting MS
should in fact be treated [21, 54]. To answer these questions, it is important to know
the natural history of the disease.
The public associates a diagnosis of MS with the need for a wheelchair and
certain disability. This misinformation may motivate many patients with a recent
diagnosis of MS or a clinically isolated syndrome to initiate long-term DMA. In
order for the patient and physician to make the best therapeutic decision for the
patient, both parties must study DMA efficacy, the side effects, mode of administration,
and costs, and review the natural history of the disease.
In this chapter, we will describe the natural history of MS and review the
controversies regarding the entity of benign MS. We will review the indications,
efficacy, mode of action and side effect profiles of the currently available FDA
approved DMA. We will discuss the importance of evidence-based medicine and
natural history studies in treatment decision making. We will review the arguments
for and against treating all patients. We will discuss a possible change from the
blockbuster to a more individualized patient care approach. |
