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It is currently thought that inflammation is crucial in MS, leading to a disruption in the ability of nerves to conduct impulses. NTZ is the first of a new generation of anti‐inflammatory treatments for MS, which is given intravenously every 4 weeks. It is usually prescribed once other drugs have failed or when the disease is rapidly worsening.

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

Version: 2011

Crohn's disease is a chronic inflammatory disease of the intestines. Crohn's disease frequently occurs in the lower part of the small intestine, called the ileum, but it can affect any part of the digestive tract, from the mouth to the anus. The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. Natalizumab blocks the adhesion and migration of white blood cells into the gut reducing chronic inflammation associated with Crohn's disease. Four high quality studies were reviewed. The studies tested 1692 people over the age of eighteen who had moderate to severe Crohn's disease. The subjects received 1 to 3 infusions of natalizumab (at a dosage of 300 mg or weight based dosages of 3, 4 or 6 mg/kg) or placebo (fake infusions). The studies lasted for 12 weeks. The results of the studies indicate that natalizumab is effective therapy for some people with active Crohn's disease. People with active disease responded positively to even one treatment of the drug and the studies examined showed increased benefits with additional injections of natalizumab. More people improved through treatment using natalizumab than those using the fake treatments. The drug was generally well tolerated and side effects occurred infrequently. Serious side effects occurred rarely (range 7 to 11% for natalizumab and placebo patients). Few patients withdrew from the studies due to side effects (2 to 8% for natalizumab compared to 3 to 7% for placebo). Side effects that occurred during the trials included: headache, worsening of Crohn's disease, abdominal pain, arthralgia, colitis, influenza syndrome, infection, nausea, vomiting, fatigue, hypersensitivity‐like reactions, and the development of antibodies against natalizumab. Recently, it was found that two patients who received natalizumab in combination with interferon beta‐1 for multiple sclerosis and one patient who received natalizumab in combination with azathioprine for Crohn's disease developed a severe disease called progressive multifocal leukoencephalopathy (PML) resulting in two deaths. PML is a serious infection of the nervous system. However an investigation of more than 3500 patients who took natalizumab found no new cases of PML. It was discovered that PML is not always fatal and regular testing of patients could provide adequate safety and ensure the well‐being of those taking natalizumab. However, the benefits of natalizumab for people with Crohn's disease should be carefully weighed against the potential risk of serious adverse events such as the possibility of infection of the nervous system.

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

Version: 2009

Several immunotherapies have been used to treat MS, but their relative effectiveness is unclear due to the limited number of direct comparison studies. The authors of this review tried to assess the efficacy and the extent of adverse events of immunotherapies commonly used in people with MS. Eleven agents were studied, interferon ß‐1b (IFNß‐1b) (Betaseron), IFNß‐1a (Rebif and Avonex), glatiramer acetate, natalizumab, mitoxantrone, methotrexate, cyclophosphamide, azathioprine, immunoglobulins, and long‐term corticosteroids.

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

Version: 2013

How does fingolimod compare in multiple sclerosis?

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

Version: November 30, 2011

Different therapeutic strategies are available for the treatment of people with relapsing‐remitting multiple sclerosis (RRMS), including immunomodulators, immunosuppressants, and biologics. Although there is consensus that these therapies may reduce the frequency of relapses, their relative benefit (effectiveness compared to each other) in delaying new relapses or disability worsening remains unclear due to the limited number of direct comparison studies (i.e. studies comparing two or more active agents with each other).

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

Version: 2015

Multiple sclerosis (MS) is an autoimmune, inflammatory, demyelinating disease of the central nervous system. It can result in a wide range of symptoms including sensory impairment, fatigue, walking or balance problems, visual impairment, vertigo and cognitive disabilities. At present, the most commonly used MS treatments are immunomodulating agents, such as beta interferon, glatiramer acetate, natalizumab, fingolimod, teriflunomide and dimethyl fumarate. Although these agents have all been shown to reduce relapse frequency, they have little effect on the disability that characterises the progressive forms of the disease. Animal studies show the sodium (Na+) accumulation leads to intracellular calcium (Ca2+) release, and the increased calcium levels can activate the release of harmful elements. These elements contribute to axonal injury exacerbating the neurological disability. If partial blockade of voltage‐gated sodium channels could result in neuroprotection in patients with MS, this would be of benefit in preventing the progression of disability in these patients. Neuroprotection is emerging as a potentially important strategy for preventing disability progression in MS.

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

Version: 2015

Dimethyl fumarate was approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency for adults with relapsing‐remitting multiple sclerosis (RRMS). It does not require that any other medication be tried before dimethyl fumarate is prescribed. Although data from non Cochrane reviews are available, it is important to systematically evaluate its efficacy and safety as monotherapy versus placebo.

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

Version: 2015

We reviewed the evidence for giving people with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) treatment that regulates the immune system other than corticosteroids, immunoglobulin and plasma exchange.

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

Version: May 8, 2017

Sufficient data were available from 22 studies on the following drugs: cladribine (Movectro), glatiramer acetate (Copaxone), interferon beta‐1b (Betaferon), interferon beta‐1a (Rebif; Avonex), and teriflunomide (Aubagio).

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

Version: April 25, 2017

Disease‐modifying therapies (DMTs) for MS currently aim to specifically reduce inflammation in relapsing MS and promote protection and repair of the nervous system in progressive MS. Laquinimod is a new oral disease‐modifying drug (DMD) with dual properties of modulation of the immune system and protection of the nervous system. The authors of this review assessed the efficacy and safety of laquinimod in patients with MS. Concerning the outcomes, they considered relapse, disability progression, inflammatory lesion, and brain atrophy. Among the pertinent literature only one study met the inclusion criteria. The study involved a total of 1106 patients with relapsing‐remitting MS and evaluated the efficacy and safety of laquinimod as unique therapy versus placebo. As far as safety was concerned, common adverse events included headache, back pain, arthralgia, diarrhoea, cough, urinary tract infection, elevated alanine aminotransferase, insomnia, nausea, abdominal pain and sinusitis. The authors were unable to give any clear recommendations for the use of laquinimod as a DMD for MS because the study was poor quality and was funded by a pharmaceutical company. Future studies with higher methodological quality are needed to assess the potential benefits and the safety in a longer period of administration.

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

Version: 2013

This is an update of the Cochrane review "Rituximab for relapsing‐remitting multiple sclerosis" (first published in The Cochrane Library 2011, Issue 12).

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

Version: 2014

Teriflunomide was first used in rheumatoid arthritis, and is known to possess both anti‐proliferative (inhibiting cell growth) and anti‐inflammatory (counteracting a local response to cellular injury) actions. In 2012, its use was approved for these characteristics by the US Food and Drug Administration for people with relapsing (with recurrent exacerbations of neurological symptoms) forms of multiple sclerosis (MS) and in 2013 also by the European Medicines Agency.

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

Version: 2016

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