Multiple sclerosis future or investigational therapies: Difference between revisions
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==Future or investigational therapies== | ==Future or investigational therapies== | ||
===Diagnostic studies under investigation=== | ===Diagnostic studies under investigation=== | ||
New diagnostic and evolution evaluation methods are also being investigated. The measurement of [[antibody|antibodies]] against myelin [[protein]]s such as [[myelin oligodendrocyte glycoprotein]] and [[myelin basic protein]] could be useful for diagnosis.[[Optical coherence tomography]] of the eye's [[retina]] could be used as a measure of response to medication, axonal degeneration and brain atrophy.<ref>{{cite journal |author=Albrecht P, Fröhlich R, Hartung HP, Kieseier BC, Methner A |title=Optical coherence tomography measures axonal loss in multiple sclerosis independently of optic neuritis |journal=J Neurol |volume=Online |issue= |pages = 1595|year=2007 |pmid=17987252 |doi=10.1007/s00415-007-0538-3}}</ref><ref>{{cite journal |author=Gordon-Lipkin E, Chodkowski B, Reich DS ''et al'' |year=2007 |month=October |title=Retinal nerve fiber layer is associated with brain atrophy in multiple sclerosis |journal=Neurology |volume=69 |issue=16 |pages=1603–09 |pmid=17938370 | doi = 10.1212/01.wnl.0000295995.46586.ae <!-- Retrieved from CrossRef by DOI bot -->}}</ref> Currently there are no clinically established laboratory investigations available that can predict prognosis. However, several promising approaches have been proposed, such as the measurement of a[[lipid]]-specific [[immunoglobulin M]] as predictor of long-term outcomes.<ref name="pmid18755821">{{cite journal | New diagnostic and evolution evaluation methods are also being investigated. The measurement of [[antibody|antibodies]] against myelin [[protein]]s such as [[myelin oligodendrocyte glycoprotein]] and [[myelin basic protein]] could be useful for diagnosis. [[Optical coherence tomography]] of the eye's [[retina]] could be used as a measure of response to medication, axonal degeneration and brain atrophy.<ref>{{cite journal |author=Albrecht P, Fröhlich R, Hartung HP, Kieseier BC, Methner A |title=Optical coherence tomography measures axonal loss in multiple sclerosis independently of optic neuritis |journal=J Neurol |volume=Online |issue= |pages = 1595|year=2007 |pmid=17987252 |doi=10.1007/s00415-007-0538-3}}</ref><ref>{{cite journal |author=Gordon-Lipkin E, Chodkowski B, Reich DS ''et al'' |year=2007 |month=October |title=Retinal nerve fiber layer is associated with brain atrophy in multiple sclerosis |journal=Neurology |volume=69 |issue=16 |pages=1603–09 |pmid=17938370 | doi = 10.1212/01.wnl.0000295995.46586.ae <!-- Retrieved from CrossRef by DOI bot -->}}</ref> Currently there are no clinically established laboratory investigations available that can predict prognosis. However, several promising approaches have been proposed, such as the measurement of a [[lipid]]-specific [[immunoglobulin M]] as predictor of long-term outcomes.<ref name="pmid18755821">{{cite journal | ||
| author=Thangarajh M, Gomez-Rial J, Hedström AK, ''et al'' | | author=Thangarajh M, Gomez-Rial J, Hedström AK, ''et al'' | ||
| title=Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis | | title=Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis | ||
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| doi=10.1177/1352458508095729 | | doi=10.1177/1352458508095729 | ||
| url= | | url= | ||
}}</ref> | }}</ref> | ||
=== Therapies under investigation === | === Therapies under investigation === | ||
Revision as of 19:11, 27 August 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Future or investigational therapies
Diagnostic studies under investigation
New diagnostic and evolution evaluation methods are also being investigated. The measurement of antibodies against myelin proteins such as myelin oligodendrocyte glycoprotein and myelin basic protein could be useful for diagnosis. Optical coherence tomography of the eye's retina could be used as a measure of response to medication, axonal degeneration and brain atrophy.[1][2] Currently there are no clinically established laboratory investigations available that can predict prognosis. However, several promising approaches have been proposed, such as the measurement of a lipid-specific immunoglobulin M as predictor of long-term outcomes.[3]
Therapies under investigation
A number of treatments that may curtail attacks or improve function are under investigation. Some of these treatments involve the combination of drugs that are already in use for multiple sclerosis, such as the joint administration of mitoxantrone andglatiramer acetate (Copaxone).[4] However, most treatments already in clinical trials involve drugs that are used in other diseases. These are alemtuzumab (trade name Campath),[5] daclizumab (trade nameZenapax),[6]inosine,[7]BG00012,[8] fingolimod,[9] and teriflunomide, the active metabolite of theDMARD leflunomide. Alemtuzumab performed better than interferon beta-1a in relapsing-remitting MS reducing disability, imaging abnormalities and frequence of relapses, at the cost of increased autoimmunity problems. These included three cases ofthrombocytopenic purpura which led to the suspension of the therapy.[10]
Other drugs in clinical trials have been designed specifically for MS, such as laquinimod,[11] and Neurovax.[12]
Low dose naltrexone has been prescribed off-label for certain autoimmune disorders, including MS, and there is anecdotal evidence of benefit,[13][14] but only two small clinical trials have been conducted (as on December 2008), one in San Francisco, USA,[15] the other for the primary progressive variety in Milan, Italy.[16]
References
- ↑ Albrecht P, Fröhlich R, Hartung HP, Kieseier BC, Methner A (2007). "Optical coherence tomography measures axonal loss in multiple sclerosis independently of optic neuritis". J Neurol. Online: 1595. doi:10.1007/s00415-007-0538-3. PMID 17987252.
- ↑ Gordon-Lipkin E, Chodkowski B, Reich DS; et al. (2007). "Retinal nerve fiber layer is associated with brain atrophy in multiple sclerosis". Neurology. 69 (16): 1603–09. doi:10.1212/01.wnl.0000295995.46586.ae. PMID 17938370. Unknown parameter
|month=ignored (help) - ↑ Thangarajh M, Gomez-Rial J, Hedström AK; et al. (2008). "Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis". Mult. Scler. doi:10.1177/1352458508095729. PMID 18755821. Unknown parameter
|month=ignored (help) - ↑ United Kingdom early Mitoxantrone Copaxone trial. Onyx Healthcare (2006-01-01). Retrieved on 2007-09-02.
- ↑ Genzyme and Bayer HealthCare Announce Detailed Interim Two-Year Alemtuzumab in Multiple Sclerosis Data Presented at AAN. Genzyme (2007-02-01). Retrieved on 2007-09-02.
- ↑ Daclizumab. PDL Biopharma (2006-01-01). Retrieved on 2007-09-02.
- ↑ Treatment of Multiple Sclerosis Using Over the Counter Inosine. ClinicalTrials.gov (2006-03-16). Retrieved on 2007-09-02.
- ↑ Efficacy and Safety of BG00012 in Relapsing-Remitting Multiple Sclerosis. ClinicalTrials.gov (2007-09-01). Retrieved on 2007-11-12.
- ↑ Efficacy and Safety of Fingolimod in Patients With Relapsing-Remitting Multiple Sclerosis. ClinicalTrials.gov (2006-02-09). Retrieved on 2007-09-02.
- ↑ The CAMMS223 Trial Investigators (2008). "Alemtuzumab vs. Interferon Beta-1a in Early Multiple Sclerosis". N Engl J Med. 359 (17): 1786–1801. PMID 18946064.
- ↑ Polman C, Barkhof F, Sandberg-Wollheim M, Linde A, Nordle O, Nederman T (2005). "Treatment with laquinimod reduces development of active MRI lesions in relapsing MS". Neurology. 64 (6): 987–91. doi:10.1212/01.WNL.0000154520.48391.69. PMID 15781813.
- ↑ Darlington CL (2005). "Technology evaluation: NeuroVax, Immune Response Corp". Curr. Opin. Mol. Ther. 7 (6): 598–603. PMID 16370383.
- ↑ Agrawal YP (2005). "Low dose naltrexone therapy in multiple sclerosis". Med. Hypotheses. 64 (4): 721–4. doi:10.1016/j.mehy.2004.09.024. PMID 15694688.
- ↑ search of clinicaltrials.gov data-base for Low dose naltrexone Multiple Sclerosis
- ↑ 2007 clinical trial using LDN
- ↑ Gironi M, Martinelli-Boneschi F, Sacerdote P, Solaro C, Zaffaroni M, Cavarretta R, Moiola L, Bucello S, Radaelli M, Pilato V, Rodegher M, Cursi M, Franchi S, Martinelli V, Nemni R, Comi G, Martino G (2008). "A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis". Multiple Sclerosis. 14 (8): 1076–83. PMID 18728058.