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Three FDA-approved oral medications are available for the treatment of relapsing forms of multiple sclerosis: fingolimod, teriflunomide, and dimethyl fumarate. While injection and IV treatments have proven to be beneficial, these newer oral agents also offer positive outcomes for patients. Numerous barriers exist, though, for these oral agents, including the unknown long-term efficacy and safety and potential side effects. Despite possible side effects, oral agents provide convenience, ease of use, and the elimination of injection/IV administration-site pain. To ensure MS patients receive the most appropriate individualized care, clinicians should present all of the available treatment options to both newly diagnosed and established patients., (© Copyright 2014 Physicians Postgraduate Press, Inc.)

Background: First-line agents approved in the United States for treatment of relapsing multiple sclerosis (MS) include intramuscular interferon beta (IFNbeta)-1a, subcutaneous (SC) IFNbeta-1a, SC IFNbeta-1b, and SC glatiramer acetate. Intravenous mitoxantrone is the only agent approved for secondary progressive MS, progressive relapsing MS, and worsening relapsing MS. Intravenous natalizumab is approved for relapsing forms of MS generally in patients who have an inadequate response to, or are unable to tolerate, first-line therapies. Corticosteroids are commonly used to treat relapses. This paper reviews the incidence and management of common adverse events (AEs) associated with these treatments., Methods: MEDLINE and EMBASE were searched for clinical trials and other publications between 1985 and 2007 reporting AEs associated with MS therapies, using these search terms: multiple sclerosis, interferon, Avonex, Betaseron, Rebif, glatiramer, copolymer 1, Copaxone, mitoxantrone, natalizumab, adverse events., Results: A class-specific flu-like syndrome associated with IFNbeta can be managed through initial dose escalation and administration of analgesics and antipyretics, prophylactically or symptomatically. Injection-site reactions can occur in patients receiving injectable therapies, particularly SC IFNbeta or glatiramer acetate. The greatest risk to patients receiving mitoxantrone is cardiotoxicity; thus, the cumulative dose is limited. Allergic reactions occur rarely with natalizumab, and there is a potential risk of progressive multifocal leukoencephalopathy. AEs associated with short-term pulse corticosteroid therapy are usually transient and largely resolve after treatment is completed., Conclusions: To improve adherence to therapy, it is important to educate patients regarding AEs and to manage AEs proactively.

The aetiology of multiple sclerosis (MS) remains unknown. Epidemiological, clinical and pathological data support the theory that MS is a complex disease/syndrome with many factors affecting its development and progression. It may be appropriate to regard MS as a syndrome with differing clinical and pathological features occurring along a spectrum. Patients with MS are more likely to have an affected relative than are individuals without MS, which suggests that there is a genetic component to this illness. Despite this genetic susceptibility, 85% of MS patients do not have an affected relative and only 1 in 3 monozygotic (identical) twins develops MS if the other twin already has it. These data strongly suggest that environmental factors influence the development of MS. Many putative infectious agents have been proposed to be involved in the aetiology of MS. Although research into identifying MS-causative agents dates back for more than 5 decades, no agent has yet emerged with any consensus as the cause of MS. This controversy is due to a number of factors, including lack of specificity of an agent to MS, lack of reproducibility in other laboratories, inappropriate controls, laboratory contamination and lack of a standard and easily reproducible assay system. Chlamydia pneumoniae is a recently described pathogen that may have a role in the pathogenesis of MS. C. pneumoniae is an intracellular bacterial organism that is infectious to humans. It has recently been detected in the cerebrospinal fluid (CSF) of MS patients but not in that of patients with other neurological diseases. There is also a case report of a patient with CNS C. pneumoniae infection and rapidly progressive MS responding to antimicrobial therapy directed against this pathogen. An association between C. pneumoniae in the CSF and MS is now apparent, but its role in the development of MS remains unknown. Further work exploring the role of C. pneumoniae in inflammatory demyelination is required. This may be accomplished either by developing an animal model or in a therapeutic trial in patients with MS.