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Neurol Sci. 2008 Sep;29 Suppl 2:S250-2. doi: 10.1007/s10072-008-0953-y.

Induction vs. escalation of therapy for relapsing multiple sclerosis: the evidence.

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Multiple Sclerosis Research Unit, The Ottawa Hospital General Campus, University of Ottawa, Ottawa, Canada.


Not all patients presenting with their first attack of multiple sclerosis (MS) or early thereafter are necessarily in the same phase of disease; some truly present early with minimal disease, whereas others present late, having accumulated already considerable damage to the central nervous system (CNS). This beckons a different approach to therapy depending on "where" a patient may be in the course of disease. If early, then any of the current first line immunomodulating agents may be appropriate, whereas later disease calls for a more aggressive approach entailing either induction with a more powerful but riskier treatment or an escalation approach, moving through first line agents and stepping up to more aggressive treatments. This paper discusses the rationale for either regimen.

[Indexed for MEDLINE]

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