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Beginning of the end of two-stage theory purporting that inflammation then degeneration explains pathogenesis of progressive multiple sclerosis

Steinman, Lawrence; Zamvil, Scott S.

Current Opinion in Neurology: June 2016 - Volume 29 - Issue 3 - p 340–344
doi: 10.1097/WCO.0000000000000317
INFLAMMATORY DISEASES AND INFECTION: Edited by Jack Antel
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Purpose of review The review discusses future directions in research on multiple sclerosis and neuromyelitis optica, as long-held beliefs about these diseases are undermined with data from recent clinical trials.

Recent findings Results of clinical trials for registration (phase 3) were reported in the last year. Anti-inflammatory approaches, such as daclizumab high-yield process targeting IL-2 receptor, and ocrelizumab targeting CD20 B cells, confirmed a beneficial role of immune suppression in relapsing–remitting disease. And now for the first time achieving the primary end point in primary progressive multiple sclerosis was attained with ocrelizumab.

Summary The results in the past year challenge the long-held belief that relapsing–remitting disease is inflammatory, whereas progressive forms of the disease are ‘less inflammatory’ and more ‘degenerative.’

aDepartment of Neurology and Neurologic Sciences, Interdepartmental Program in Immunology, Stanford University, Stanford

bDepartment of Neurology and Program in Immunology, University of California, San Francisco, California, USA

Correspondence to Lawrence Steinman, MD, Department of Neurology and Neurologic Sciences, Interdepartmental Program in Immunology, Stanford University, Stanford, CA 94305, USA. E-mail: steinman@stanford.edu

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