Review of the main therapies for Multiple Sclerosis
In Multiple Sclerosis there is an altered regulation of the immune response of the patient when hyperactivated immune cells reach the central nervous system. There, they trigger an inflammatory reaction, attack and destroy myelin and damage the cells that produce it, the oligodendrocytes.
Consequently, the good functioning of the central nervous system is altered, generating motor and cognitive dysfunctions that can be translated into a wide range of symptoms, depending on the person and type of multiple sclerosis.
Currently, there is no curative treatment for multiple sclerosis. The available therapies aim at modifying the evolution of the disease and at alleviating its symptoms, and controlling episodes of neuroinflammation, but not neurodegeneration. This is one of the fundamental reasons why there are hardly any therapeutic options for people with progressive forms of multiple sclerosis.
The treatment of the associated symptoms has been approached from two different, necessary and complementary prisms:
- The pharmacological one tries to modify the course of the disease,
- The rehabilitative one aims preserving and conserving functionality in daily life.
In this document we summarize the pharmacological approach and, in particular, the therapies currently available and the new therapeutic strategies under investigation.
CURRENT PHARMACOLOGICAL THERAPIES
The treatments marketed are focused on two states of MS:
The marketed treatments focus on two MS states:
a) Treatment of outbreaks
Outbreaks or relapses are treated with corticosteroids which, due to their anti-inflammatory properties, can reduce their duration and severity. Corticosteroids are a class of hormones of the steroid group (produced by the cortex of the adrenal glands) and their derived products.
Corticosteroids have an anti-inflammatory and antiallergic action on a large number of physiological mechanisms, including those that regulate the immune system. In addition, they maintain the concentration of sugar in the blood, blood pressure and muscle strength, and contribute to the electrolyte balance. One of their main properties is to stop the development of certain immune reactions against an infection.
They also have side effects, some less than others, and can cause intestinal, gastric and digestive problems. As their therapeutic effects are transitory and the pathological process can reappear once the medication is suspended, their administration is gradually diminished to prevent the symptoms from reappearing.
b) Disease modifying treatments
Until now, immunotherapy has been the main therapeutic strategy to fight multiple sclerosis.
Immunomodulatory drugs or immunosuppressants allow to control the autoimmune response and inflammation by acting on the cells responsible for the immune system and the central nervous system. Thus, they help decrease the neurodegeneration associated with multiple sclerosis.
with Multiple Sclerosis.
Objectives of Immunotherapy:
- In the short term, they control inflammation and prevent new outbreaks.
- In the long-term, they slow down the progression of the disability.
Table of drugs approved by the European Medicines Agency (EMA) between 2011 and January 2018
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