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 Volume 72, Number 11, March 17, 2009
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NEUROLOGY 2009;72:1008-1015
© 2009 American Academy of Neurology
Views and Reviews

Multiple sclerosis therapeutics

Unexpected outcomes clouding undisputed successes Heinz Wiendl, MD and Reinhard Hohlfeld, MD

From the Department of Neurology (H.W.), Julius-Maximilians-University Würzburg, Germany; and the Institute of Clinical Neuroimmunology (R.H.), Ludwig Maximilians University of Munich, Germany.

Address correspondence and reprint requests to Prof. Heinz Wiendl, Department of Neurology, Julius-Maximilians-University Würzburg, Josef-Schneider Str. 11, 97080 Würzburg, Germany heinz.wiendl{at}klinik.uni-wuerzburg.de

In this essay, we draw attention to some recent downsides and surprises of multiple sclerosis (MS) therapeutics. These include experiences with recent head-to-head trials of interferon-beta and glatiramer acetate, dose escalation trials, frustrating efforts with progressive MS trials, failures of smart concepts and designer therapies, and harsh lessons from newly observed adverse reactions.

Abbreviations: DMT = disease-modifying therapy; EAE = experimental autoimmune encephalomyelitis; EDSS = Expanded Disability Status Scale; GA = glatiramer acetate; IFNβ = interferon beta; ITP = idiopathic thrombocytopenic purpura; IVIg = IV immunoglobulin; MS = multiple sclerosis; PML = progressive multifocal leukoencephalopathy; PPMS = primary progressive multiple sclerosis; RCT = randomized controlled trial; RRMS = relapsing remitting multiple sclerosis; SC = subcutaneously; TNF{alpha} = tumor necrosis factor {alpha}.

Disclosure: H.W. received honoraria for lecturing and travel expenses for attending meetings and received financial research support from Bayer, Biogen Idec/Elan, Sanofi-Aventis, Schering, Serono, and Teva Pharmaceuticals. H.W. has served or serves as consultant for Serono, Medac, Sanofi-Aventis/TEVA, Biogen Idec, and Schering. R.H. received personal compensation from Bayer, Schering, Serono, Biogen-Idec, Teva/Sanofi-Aventis, and Novartis.

Supplemental data at www.neurology.org

Received March 20, 2008. Accepted in final form December 16, 2008.




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[Abstract] [PDF]