Rationale and experience with combination therapies in MS 

Standard immunomodulatory therapies for multiple sclerosis reduce  relapses by around 30% and possibly slow progression of  disability. In many patients, use of such treatments allows the  disease process to be stabilised and quality of life to be improved. 

However in patients experiencing frequent severe relapses, for whom  prognosis is often poor, they may not be sufficiently efficacious.  Emerging therapies such as natalizumab, alemtuzumab, or mitoxantrone  may be more effective in such patients but have potentially greater  side-effects that limit their use as maintenance therapies.

Combining current immunomodulatory treatments with emerging therapies may offer the potential to treat patients with active disease successfully and  safely. In particular, the use of induction therapy with mitoxantrone  followed by maintenance treatment with glatiramer acetate appears to  be of interest. In a cohort of over 60 patients receiving this  combination in routine clinical practice, disease activity as  measured by relapses is rapidly suppressed and the benefit sustained  for over five years. With current, anti-inflammatory, therapies  decisions on switching and combining therapies need to be made early  in the disease course in order to optimise benefit for patients and  minimise the risk of accumulating irreversible disability.