Many therapeutic advances for relapsing-remitting multiple sclerosis (MS) have occurred in the past 25 years. Although similar advances in disease-modifying therapies have not been realized in progressive MS, many symptomatic therapeutic strategies can benefit patients with progressive MS. Few guidelines exist for management of patients with progressive MS.
The classification of progressive MS was revised in 2013 to include a description of inflammatory disease activity determined by clinical relapses or imaging findings. Developing knowledge about the pathogenesis of progressive MS and the role of comorbidities in modifying the disease course has implications for the clinical management of patients with progressive MS as well as for clinical trial design. Current and upcoming clinical trials will assess a wide range of interventions, including immunomodulatory agents, putative neuroprotective molecules, stem cell therapy, nutrition, and rehabilitation techniques.
None of the therapies currently approved for use in relapsing-remitting MS have been shown to slow the gradual progression of disability that occurs in the absence of recent relapses or changes in MRI. A multidisciplinary approach is needed to address the many symptoms that impact quality of life for patients with progressive MS.
Address correspondence to Dr Mary Alissa Willis, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Ave U10, Cleveland, OH 44195, firstname.lastname@example.org.
Relationship Disclosure: Dr Willis serves on the board of directors of the Multiple Sclerosis Association of America and on the editorial board of the International Journal of MS Care. Dr Willis has received personal compensation for speaking engagements from Biogen and Sanofi Genzyme and research support from Biogen. Dr Fox serves on the scientific advisory board of MedDay Pharmaceuticals and on the editorial boards of the Multiple Sclerosis Journal and Neurology. Dr Fox serves as a consultant for Actelion Pharmaceuticals Ltd, Biogen, Mallinckrodt Pharmaceuticals, Novartis AG, Teva Pharmaceutical Industries Ltd, and XenoPort, Inc. Dr Fox receives royalties from Elsevier B. V. and research support from the National Institutes of Health, the National Multiple Sclerosis Society, and Novartis AG.
Unlabeled Use of Products/Investigation Use Disclosure: Drs Willis and Fox discuss the unlabeled/investigational use of pharmaceuticals for the treatment of progressive multiple sclerosis. Mitoxantrone is the only medication approved by the US Food and Drug Administration for secondary progressive multiple sclerosis.