Multiple sclerosis: Difference between revisions

There are many other treatments for MS ranging from small polymers to monoclonal antibodies to cytotoxic agents. While all have their benefits, they also have their side effects. While clinical trials can out short-term effects, long-term effects are a continuous threat and worry to contend with. Treatment of women, who are more effected than males, is particularly dangerous when the woman is potentially pregnant. Another great concern is the safety of treating children.<ref name='MS:Pathogenesis and Treatment' />  

Formerly known as copolymer 1, '''glutarimer acetate''' (GA) is a random polymer of glutamic acid, lysine, alanine, and tyrosine which are the most common amino acids in MBP. As with Interferon-β, the exact mechanism of glutarimer acetate is not yet known, although Racke et al. have shown that GA inhibits response of various antigen-specific murine T cell hybridomas in addition to blunting human MBP-specific T cell lines from lysing targets in the presence of three human leukocyte antigen-DR types associated with MS. Additionally, studies have shown that GA increases cytokine levels, anti-inflammatory action, and acts upon CD8+D T cells by correcting their regulatory deficit. The only drug on the market is called ''Copaxone'' and it is approved for use of treatment of RRMS. It has shown effects on exacerbation rate and MRI clinical assessment. ''Copaxone'' is injected subcutaneously on a daily basis.<ref name='MS:Pathogenesis and Treatment' />

'''Monoclonal antibodies''' have been studied since the 1980s and a great deal is known about them. There are three different types that are differentiated by their structural similarity to human antibody structure. Humanized antibodies have more than 90% human components with the rest being murine. These include natalizumab, alemtuzumab, and daclizumab. Rituximab is a chimeric antibody, which contain at least 66% human sequence and structure. Monoclonal antibodies have specific targets and as such have varying mechanisms of binding, blocking, or signaling.<ref name='MS:Pathogenesis and Treatment' /> 

Some clinicians will use cytotoxic agents to treat MS, although only mitoxantrone is FDA approved for the treatment of MS. Off label use of cytotoxic agents is based on small studies, and cyclophosphamide, azathioprine, methotexate, and mycophenolate mofetil are the most frequently used. Their mechanism of action appears to be a broad immunosurppressive action, and these agents have much more severe side effects, such as an increase of infections and neoplasia, than the other more traditional treatments. Immunomodulatory agents, such as intravenous immunoglobulin and corticosteroids, are also sometimes used.<ref name='MS:Pathogenesis and Treatment' />