High-Efficacy Therapies for Treatment-Naïve Individuals with Relapsing–Remitting Multiple Sclerosis

Abstract

There are > 18 distinct disease-modifying therapy (DMT) options covering 10 mechanisms of action currently approved by the US Food and Drug Administration for the treatment of relapsing-remitting multiple sclerosis (RRMS). Given the multitude of available treatment options, and recent international consensus guidelines offering differing recommendations, there is broad heterogeneity in how the DMTs are used in clinical practice. Choosing a DMT for newly diagnosed patients with MS is currently a topic of significant debate in MS care. Historically, an escalation approach to DMT was used for newly diagnosed patients with RRMS. However, the evidence for clinical benefits of early treatment with high-efficacy therapies (HETs) in this population is emerging. In this review, we provide an overview of the DMT options and MS treatment strategies, and discuss the clinical benefits of HETs (including ofatumumab, ocrelizumab, natalizumab, alemtuzumab, and cladribine) in the early stages of MS, along with safety concerns associated with these DMTs. By minimizing the accumulation of neurological damage early in the disease course, early treatment with HETs may enhance long-term clinical outcomes over the lifetime of the patient.

Graphene Oxide as a Novel Immunotherapy Tool for the Modulation of Myeloid-Derived Suppressor Cell Activity in the Context of Multiple Sclerosis

“…6.5 eV from the main C 1s peak, which is clearly linked to the characteristic π-π* shake-up transition consistent with the majority existence of sp 2 bonding in the sample. Note that a small amount of disordered regions where C atoms with defect-like sp 2 /sp 3 bonding nature might also exist and those are included in the C-C component, but with no significant weight due to the low chemical shift and their minor contribution.…”

“…Data points in every spectrum are represented as open symbols and Shirley background and component peaks using solid lines. The fitting curve (red line) resulted from the addition of several contributions belonging to: C-C bonding for GO (C-H, C-C defective sp 3 15 . In an attempt to use MDSCs for future cell-based therapies, and encouraged to the reported implications of GDMs on cell differentiation 22 , rGO2002D films were used to modulate the phenotype of SP-MDSCs in vitro (Figure2A).…”

“…85% of MS patients experience the relapsing-remitting MS (RRMS) in which periods of symptoms exacerbation are followed by full or partial recoveries 2 . Due to an extensive investigation in MS therapy, over 18 disease modifying treatments (DMTs) are available for RRMS devoted to control relapses and slow the progression of disability 3 . However, in an important proportion of RRMS patients showing early and highly active MS, the risk of disability accumulation is high and for many of them current DMTs provide suboptimal efficacy, with cell therapy being the only alternative 4, 5 .…”

Suppression of Multiple Sclerosis by Ultraviolet Light

“…Despite recognition of multiple sclerosis as a disease since the middle of the 19 th century, it was only about 30 years ago that the first drug, interferon beta-1b, was approved by the FDA for treatment 12 . There are now nearly 20 drugs approved for MS 13 . These therapies reduce relapse rates and slow progression, but do not reverse or prevent completely disease progression.…”

“…These results in mice are corroborated with findings in CIS patients where increases in circulating T-cells were observed after exposure to narrow band UVB 45 . Several drugs based on this pathway are currently marketed for MS treatment 13 . Another potential target for explaining the UV suppression of multiple sclerosis is the folic acid pathway.…”