Therapies for multiple sclerosis have emerged over the last decades with the demonstration of efficacy of immunomodulating therapies that impact the course of early multiple sclerosis;  Immunosuppressive drugs such as mitoxantrone and cyclophosphamide; Beta-interferons; an MHC-binding protein that engages the T Cell Receptor (TCR), and glatiramer acetate (GA) are all such a class of therapy [12].
Since the market is split between drugs, there has been intense marketing for market share by pharmaceutical companies.  Much impetus has focused on companies competing to position a superior product.  Marketing devices have taken many forms including physician and lay advocates, advertising, educational programs and postmarketing studies.  There has been an array of claims and counterclaims as exchange [78].

Long term randomized placebo controlled studies to assess the long term impact of disease modifying therapies are thought unlikely to occur firstly because prolonged use of  a placebo group in Relapsing Remitting Mulitple Sclerosis (RRMS) is deemed ethically questionable, and secondly, patients in a clinical trial are most likely to withdraw if they are doing poorly, thus increasingly making the results unreliable [78].
The pivotal RRMS interferon trials changed the perception of multiple sclerosis from an untreatable to a treatable condition which has had profound scientific, psychological, economic and practical implications.
The market for multiple sclerosis disease therapy quickly developed with world wide sales of interferon products exceeding $2.5 billion.  This has driven pharmaceutical investment in multiple sclerosis research.  Studies were initiated to evaluate the effects of interferon in SPMS and at the time of a clinically isolated syndrome as well as numerous head to head comparison studys [78].

The underlying pathology of multiple sclerosis as an inflammatory central nervous system disease was instrumental in leading to the drug treatments presently used.  Examination of these drug’s mechanisms of action has provided insight into the etiology of multiple sclerosis [12].

The use of beta interferon and glatiramer acetate for the treatment of multiple sclerosis has, to some extent, changed the course of the disease.  The annual relapse rate of patients treated with these drugs is lower than that in placebo treated patients, and more treated patients remain relapse free compared with untreated patients.
In addition, these compounds reduce the development of new lesions, as detected by MRI.  The limited effectiveness of approved treatments for multiple sclerosis, as well as reports of adverse events and toxicity, emphasize the need for the development of new and existing therapies with improved efficacy and fewer side effects.  Advances in biotechnology have led to several new therapeutic approaches to the treatment of multiple sclerosis [30].

Treatment of multiple sclerosis may be divided into [64]:

• Disease modifying therapy
• Treatment of complications
• Treatment of symptomatic relief during an exacerbation
• The specific agents used depend on progression of the disease at the time of diagnosis.

Bibliography