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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

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 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

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

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: 2011

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

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

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 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

Treatments with Viagra (Sildenafil citrate)  for erectile dysfunction in male patients aged more than 18 years old with multiple sclerosis

Erectile dysfunction (ED) is a common sexual disease in male patients with multiple sclerosis (MS). Viagra (Sildenafil citrate) is considered as an effective drug for  the treatment of ED in the general population, but it has not been systematically reviewed in patients with MS.

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

Version: 2012

Non pharmacological interventions for treatment of spasticity in Multiple Sclerosis (MS)

Spasticity is a common and debilitating symptom, causing ‘stiffness’, ‘spasms’ or ‘tightness’ in the weakened arm or leg in people with multiple sclerosis (MS). Overall, spasticity is difficult to treat. Current treatments include various medications (such as botulinum toxin injections to relax the affected muscles) and non drug methods aiming to achieve functional goals for patients (and their caregivers) such as physiotherapy, magnetic stimulation, electromagnetic therapy, vibration therapy. In this review, nine studies evaluating various non drug treatments to treat spasticity in adult with MS were included, comprising a total of 341 participants. Results from these studies suggest that all included non pharmacological therapies have low level of evidence or no evidence in improving spasticity in people with MS. However, caution should be used in the interpretation of the results, due to the poor methodological quality of all the included studies. More research is needed to determine the usefulness of these interventions before they can be recommended as routine treatments.

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

Version: 2013

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 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 deleterious effects were described in the included studies.

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

Version: 2015

Vitamin D for the management of multiple sclerosis

Multiple sclerosis is an illness in which the myelin sheaths around the nerves of the brain and spinal cord are damaged, affecting the ability of nerve cells to communicate with each other. A wide range of clinical presentations and neurological symptoms can occur with the disease, and these can progress to physical and cognitive disability often with a variable clinical course. Although very little is known about the mechanism and causes of this disease genetic, immunologic and environmental factors have all been implicated. Studies have shown a characteristic geographical pattern of disease distribution both in occurrence and progression, which appear to be correlated with sun light exposure and lack of vitamin D and are considered to be predisposing factors for MS. Vitamin D deficiency is said to affect the general well being of patients with MS and is also associated with poorer neurologic outcomes. People suffering with MS are usually given regular vitamin D preparations after assessment of their serum levels of vitamin D.This review sought to evaluate the benefits and harms of this Vitamin D administration to people of MS.The current level of evidence from this review is based on only one trial with potential high risk of bias, which does not at present allow confident decision‐making about the use of Vitamin D in MS. The review authors suggest that until further high‐level evidence is available, clinicians should continue to follow local guidelines when administering vitamin D to people with MS.However, the question of the safety and effectiveness of Vitamin D in people of MS remains unanswered.

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

Version: 2011

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

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

The use of interferons for treating people with the relapsing‐remitting form of multiple sclerosis

Multiple sclerosis (MS) is a chronic disease of the nervous system which affects young and middle‐aged adults. Repeated damage to the myelin sheaths and other parts of the nerves can lead to serious disability. MS may be related to the immune system. Interferons have several effects on the immune system, and act against viruses. Interferons can help to reduce disability and attacks for people with multiple sclerosis, but there is not enough evidence about their usefulness in the long term. The review of trials found that interferons administered intramuscularly or subcutaneously can lead to a moderate reduction in recurrences and disability in people who have MS with remissions. Interferon‐1a administered by the oral route was not effective for prevention of relapses. Side effects were usually influenza‐like symptoms, injection site‐reactions, pains in the joints and muscles, fatigue and headache.

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

Version: 2008

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