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Comparing Drugs for Multiple Sclerosis

How do disease-modifying drugs compare in multiple sclerosis?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: February 11, 2011

Dimethyl fumarate (Tecfidera) for multiple sclerosis: Overview

Dimethyl fumarate (trade name: Tecfidera) has been approved in Germany since January 2014 for adults with relapsing remitting multiple sclerosis.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 1, 2014

Treatment of seizures for patients with multiple sclerosis

Epileptic seizures occur in a relatively small number of patients with multiple sclerosis, but can have serious consequences. Because the cause of epileptic seizures in patients in MS may be different from that in other forms of epilepsy, it is uncertain whether patients with MS should be treated differently. We searched for studies on the treatment of epileptic seizures in patients with MS, but found none. Well designed studies that address this issue are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

The use of methotrexate, an immunomodulator drug, for treating people with multiple sclerosis

Multiple sclerosis (MS) is an immune disease of the nervous system. Drugs that interfere with the immune system, such as methotrexate could benefit people with the disease. To date research suggest that there may be small improvements from treatment with methotrexate. However, until these improvements need to be balanced against methotrexate's potentially serious side‐effects. Until larger research studies are performed, it will be too early to say whether the benefits of this drug outweigh its side‐effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Hyperbaric oxygen therapy, which involves people breathing pure oxygen in a specially designed chamber, for the treatment of multiple sclerosis

Multiple sclerosis (MS) is a chronic disease of the nervous system which affects young and middle‐aged adults. Repeated damage to parts of the nerves leads to progressive weakness and disability. Hyperbaric oxygen therapy (HBOT) involves people breathing pure oxygen in a specially designed chamber (such as used for deep sea divers suffering pressure problems after resurfacing). HBOT is sometimes used for MS in case a lack of oxygen to the affected nerves may be making MS worse, but this theory is unproven. The review of nine trials found no consistent evidence that HOBT can improve disability or modify the progression of MS. There is little need for further research.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

The effect of anti‐spasticity agents in people with multiple sclerosis

Multiple sclerosis (MS) is a chronic disease of the nervous system which affects young and middle‐aged adults. Spasticity, a common problem in people with MS, is a disorder of voluntary movement caused by damage to the central nervous system. The main sign is the resistance to passive movement of a limb but other associated features ‐ pain, spasms, loss of function ‐ affect people's quality of life more directly.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

The use of different treatment for incoordination of limb movement (ataxia) or tremor in people with multiple sclerosis

MS is a chronic disease of the central nervous system which typically affects both young and middle aged adults. It can result in many different symptoms including ataxia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Anticholinergic drugs in subjects with Multiple Sclerosis (MS) and urinary symptoms.

Urinary symptoms are very common in people with multiple sclerosis, reflecting the high prevalence of damage to the spinal cord from MS. Symptoms may change with time due to either progression or MS relapses. Common symptoms include frequency, urgency and urinary incontinence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

The effect of amantadine for the treatment of fatigue in people with multiple sclerosis

Multiple sclerosis (MS) is a chronic disease affecting young and middle‐aged adults. One of the most common and disabling symptoms of MS is fatigue. Different approaches have been used to try and improve this, including energy conservation, specialised fitness training and drug treatments. Amantadine has been used to try to relieve fatigue in MS. This review found that Amantadine efficacy in reducing MS‐related fatigue and its tolerability are poorly documented and more research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Drug treatment for depression in multiple sclerosis

Many patients with multiple sclerosis (MS) suffer from depression. In this review we summarized studies of antidepressant drug treatments in patients with MS. We found two studies that met the inclusion criteria of methodological quality, comprising of a total of 70 participants: one (28 participants) reported the effects of desipramine, the other (42 participants) the effects of paroxetine. The two studies showed no improvement of depression with both treatments in the short term (five/twelve weeks). Adverse effects, such as nausea or headache occurred frequently. Further studies on drug treatment of depression in MS with a longer duration are clearly needed, as the results may be affected by the small size of participants and by the fact that many participants did not complete the studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

The effect of aminopyridine for the treatment of several symptoms in people with multiple sclerosis

Multiple sclerosis (MS) is a disease that affects young and middle‐aged adults, causing different symptoms in individuals. It is caused by damage to the myelin sheaths (fibres that wrap around and protect the nerves and spinal cord). Potassium (a mineral) is important for nerve function, but may become too active when there is not enough myelin. Potassium blocking drugs (4‐aminopyridine AP, and 3,4‐daminopyridine DAP) may be able to improve nerve function in nerves without enough myelin. However, the review of trials found there is not enough evidence about the safety of these drugs or whether benefits are certain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

The effect of the immunosuppressive drug cyclophosphamide in people with multiple sclerosis

MS is a chronic disease of the nervous system affecting young and middle‐aged adults. MS is supposed to be related to the immune system. CFX is an immunosuppressive drug used for various autoimmune diseases. As its use for MS is controversial, the Authors of this review aimed to assess CFX efficacy for patients with progressive MS. Among the pertinent literature, only five studies met the inclusion criteria of minimum methodological quality , with a total of 90 MS patients treated with CFX.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

The use of Statins, cholesterol lowering agents, in patients with multiple sclerosis (MS)

MS is an inflammatory demyelinating disease of the human central nervous system and it is thought to be related to abnormal working of the immune system. Preliminary studies have shown that statins, cholesterol lowering agents, have potential immunological regulation effects which may be beneficial for MS. Furthermore, statins are usually orally administered, are less expensive than other MS treatment, and are easily available.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Vocational Rehabilitation (VR) programs are used to support persons with multiple sclerosis ( MS) on their entering or returning to work

Major as well as minor disabilities, such as physical, psychosocial, environmental and memory/attention impairment, significantly affect the entering or the returning to work of persons with MS. The objective of this review was to assess the efficacy and to evaluate the cost effectiveness of VR programs compared to other types of programs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Occupational therapy as supportive treatment for people with multiple sclerosis

Multiple sclerosis (MS) is a chronic disease of the nervous system which affects young and middle‐aged adults. MS causes disruption of the ability of nerves to conduct electrical impulses, leading to symptoms such as muscle weakness, fatigue and loss of control over the limbs. Occupational therapy (OT) is used to try to help people with MS participate in the physical and social activities of their daily lives. The review found that there is currently no reliable evidence that OT improves outcomes for people with MS, although there was some suggestion that fatigue might be improved.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Carnitine for fatigue in patients with multiple sclerosis (MS)

Fatigue  is commonly associated with multiple sclerosis and leads to significant disability and loss of quality of life. Several kind of interventions have been carried out, but definitive evidence on their relative efficacy and tolerability are not available.  As quite recently it has been hypothesised a relationship between low carnitine levels in the blood and fatigue, and several studies showed that supplementation with carnitine produced improvement in fatigue symptoms. The Authors decided to perform a systematic review to assess the possible efficacy of carnitine in improving fatigue and to identify any adverse events in relapsing‐remitting and secondary progressive MS patients. Most of the studies did not meet the inclusion criteria of methodological  quality, but one with the enrollement of  36 patients for 12‐month intervention  with carnitine associated with amantadine, another drug commonly used to improve fatigue.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

The use of immunoglobulins (antibodies) for treating people with multiple sclerosis

Multiple sclerosis (MS) is a chronic immune‐mediated disease of the nervous system that affects young and middle‐aged adults and can lead to permanent disability. Immunoglobulins have several effects on the immune system, and help fight infections. The review of trials found there is some evidence that immunoglobulins can reduce the rate of relapses in people who have relapsing remitting MS. There is no evidence that immunoglobulins can reduce the progression of MS.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Psychological treatments to help improve the quality of life of people with multiple sclerosis

In many countries MS is the most common neurological disorder among young adults. Its impact can be overwhelming with the person facing the likelihood of reduced physical function and of disability, with consequent disruptions in education, employment, sexual and family functioning, friendships and activities of daily living. MS can have a considerable impact on the individual's sense of self, especially if they can no longer perform previously valued activities. Unpleasant side effects from medication may also occur. Mood disorders such as depression and anxiety are common in people with MS, and are often a result of finding it difficult to adjust to, and cope with, having the disorder. Cognitive functioning (the mental processes of memory, concentration, reasoning and judgement) can also be affected. Therefore a diagnosis of MS can have substantial psychological consequences.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

The impact of excercise therapy for multiple sclerosis

MS is a chronic disease of the central nervous system. The variable distribution of the damage in the myelin sheath of nerves may lead to loss of strength, sensation, co‐ordination and balance causing severe and progressive limitations of function in daily life. To date, there is no effective treatment for MS, however, a number of studies suggest that exercise interventions aimed to improve daily functioning of patients with MS are effective. Nine randomized controlled trials of exercise therapy for MS patients were included in this review six of which used no therapy as the comparator. There was strong evidence in favor of exercise therapy, compared to no therapy, regarding muscle function and mobility while no evidence was found of improved fatigue, in one study only. No one specifically targeted exercise program was more successful than others. No eleterious effects were described in the included studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Mycophenolate mofetil for relapsing‐remitting multiple sclerosis

Multiple sclerosis (MS) is an immune‐mediated disease of the central nervous system. Preliminary data show that mycophenolate mofetil (MMF), an immunosuppressive agent, might be beneficial for MS patients. The authors of this review evaluated the efficacy and safety of MMF in patients with relapsing‐remitting MS. Only one small study met the inclusion criteria, and it compared MMF versus placebo in 26 interferon β‐1a–treated patients. The results showed no evidence favoring MMF in reducing relapses or preventing disability progression after a 12‐month follow‐up period. No data were available at 24 months. All patients receiving MMF suffered from gastrointestinal upset, and one had a transient diarrhea, but no serious adverse effects were reported.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

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