TY  - CHAP
M1  - Book, Section
TI  - Multiple Sclerosis
A1  - Bainbridge, Jacquelyn L.
A1  - Miravalle, Augusto
A1  - Wong, Pei Shieen
A1  - Makelky, Matthew J.
A2  - DiPiro, Joseph T.
A2  - Yee, Gary C.
A2  - Posey, L. Michael
A2  - Haines, Stuart T.
A2  - Nolin, Thomas D.
A2  - Ellingrod, Vicki
Y1  - 2020
N1  - 
T2  - Pharmacotherapy: A Pathophysiologic Approach, 11e
AB  - KEY  CONCEPTSThe  etiology  of  multiple  sclerosis  (MS)  is  unknown,  but  it  appears  to  be  autoimmune  in  nature.  Currently  there  is  no  cure.Multiple  sclerosis  is  characterized  by  central  nervous  system  (CNS)  demyelination  and  axonal  damage.Multiple  sclerosis  is  classified  by  the  nature  of  progression  over  time  into  several  categories,  which  have  different  clinical  presentations  and  responses  to  therapy.Studies  only  support  one  FDA-approved  disease-modifying  therapy  (DMT),  ocrelizumab  (Ocrevus),  in  patients  with  progressive  forms  of  the  illness.  Information  derived  from  multiple  studies  suggests  younger  patients  with  progressive  illness  and  those  with  either  superimposed  acute  relapses  or  enhancing  lesions  on  magnetic  resonance  imaging  (MRI)  scans  may  benefit  from  some  of  the  presently  used  DMTs.The  diagnosis  of  MS  is  made  primarily  on  the  basis  of  clinical  symptoms  and  examination,  but  does  require  evidence  of  dissemination  of  lesions  over  time  in  multiple  parts  of  the  CNS  and/or  optic  nerve.  Additional  diagnostic  criteria  include  use  of  MRI,  spinal  fluid  evaluation,  and  evoked  potentials  to  aid  in  the  diagnosis.Exacerbations  or  relapses  of  MS  can  be  disabling.  When  this  is  the  case,  exacerbations  and  relapses  are  treated  with  high-dose  glucocorticoids,  such  as  intravenous  (IV)  methylprednisolone,  with  onset  of  clinical  response  typically  within  3  to  5  days.Treatment  of  relapsing-remitting  multiple  sclerosis  (RRMS)  with  the  DMTs  interferon-β  (IFN-β)  (Avonex,  Betaseron,  Rebif,  Extavia),  glatiramer  acetate  (Copaxone),  natalizumab  (Tysabri),  ocrelizumab  (Ocrevus),  mitoxantrone  (Novantrone),  fingolimod  (Gilenya),  teriflunomide  (Aubagio),  dimethyl  fumarate  (Tecfidera),  and  alemtuzumab  (Lemtrada)  can  reduce  annual  relapse  rate,  lessen  relapse  severity,  slow  progression  of  MRI  changes,  and  slow  progression  of  disability  and  cognitive  decline.  In  addition,  DMTs  have  been  shown  to  reduce  the  likelihood  of  developing  a  second  attack  after  a  first  clinically  isolated  syndrome  (CIS)  consistent  with  MS.In  most  cases,  treatment  with  DMTs  should  begin  promptly  after  the  diagnosis  of  RRMS,  or  after  a  CIS,  if  the  brain  MRI  is  suggestive  of  high  risk  of  further  attacks.  Natalizumab,  and  other  choices  that  have  been  associated  with  problematic  adverse  events,  should  be  reserved  for  those  patients  who  have  failed  one  or  more  standard  therapies  and  those  with  poor  prognostic  signs.The  definition  of  “treatment  inadequacy”  for  RRMS  remains  unclear,  and  therapy  changes  after  “treatment  failure”  should  be  individualized.Patients  suffering  with  MS  frequently  have  symptoms  such  as  spasticity,  bladder  dysfunction,  fatigue,  neuropathic  pain,  cognitive  dysfunction,  and  depression  that  may  require  treatment.  Patients  must  be  counseled  that  DMTs  will  not  relieve  these  symptoms.  Depression  is  common  in  MS  and  can  pose  the  risk  of  suicide.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesspharmacy.mhmedical.com/content.aspx?aid=1182445408
ER  -