Despite the efficacy of current therapies for relapsing forms of multiple sclerosis (MS), there remains a group of patients whose disease fails to respond and warrants a different approach to treatment. This article reviews this form of aggressive MS and proposes a definition and new treatment algorithm. Failing to recognize aggressive MS and initiate more effective therapy will result in a lost opportunity to effectively treat the disease.
Natural history studies, together with the results of contemporary clinical trials, help to identify and profile a subset of patients with relapsing MS who have a much poorer prognosis and for whom conventional treatment tends to fail. Therapies that have shown success in the treatment of this patient group with aggressive MS are reviewed and discussed.
It is imperative to recognize aggressive MS to effectively treat it before patients progress. Recognizing aggressive MS as early as possible is the key to successful implementation of a proposed algorithm.
Address correspondence to Dr Mark S. Freedman, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada, firstname.lastname@example.org.
Relationship Disclosure: Dr Freedman has served as a consultant for Opexa Therapeutics, Inc, and on the advisory boards of Actelion Pharmaceuticals Ltd; Biogen; Chugai Pharma USA, Inc; EMD Serono, Inc; F Hoffmann-La Roche Ltd; Novartis AG; Sanofi Genzyme; and Teva Pharmaceutical Industries Ltd. Dr Freedman serves on the editorial boards of Multiple Sclerosis Journal and Journal of the Neurologic Sciences. Dr Rush has served as a consultant for Sanofi Genzyme and has received personal compensation for speaking engagements from EMD Serono, Inc; the Multiple Sclerosis Society of Canada; and Teva Pharmaceutical Industries Ltd.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Freedman and Rush discuss the unlabeled/investigational use of ocrelizumab, parenteral cladribine, rituximab, and stem cell transplantation for the treatment of aggressive multiple sclerosis.