Rationale and experience with combination therapies in MS

Boggild M. Walton Centre for Neurology and Neurosurgery,

Lower Lane,  Fazakerley, Liverpool,

L9 7LJ, UK.

Standard immunomodulatory therapies for multiple sclerosis reduce  relapses by around thirty percent 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.