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Monday, June 7, 2010

What can we do to encourage MS patients who have advanced to the secondary progressive stage?

Source: Masters of MS - archived questions

We advise programs involving exercise, diet, and cognitive support, but there are no specific medications, says Howard Zwibel MD (shown below). 

Aside from medications to treat fatigue, what else can be offered?
Treatment of secondary progressive MS (SPMS) involves a comprehensive multidisciplinary approach with emotional, physical and pharmacologic intervention. Mitoxantrone is approved for secondary progressive MS, but many clinicians are reluctant to use the drug in light of newer data reported at ECTRIMS 2009 on the increased risk of cardiotoxicity and treatment-related leukemia relative to earlier estimates.

Patients who are treated early in the progressive stage may benefit from the use of cyclophosphamide. A small cohort of males with primary progressive MS was shown to benefit from glatiramer acetate treatment in one trial. Among the large number of emerging agents being studied for MS, several are being tested in progressive as well as relapsing-remitting forms of MS. In addition, we are hopeful that fampridine, a potassium channel blocker shown to increase walking speed at all stages of MS, will be approved as a new symptomatic therapy.

A multidisciplinary approach to the care of these patients should ensure that their unmet needs are being considered, including emotional issues, employment factors, use of assistive devices, evaluation of the home, etc. Much of this can be accomplished through the local chapter of the National Multiple Sclerosis Society.

Suggested reading:
Marriott J, O’Connor P. Reappraisal of the rates of serious cardiotoxicity and therapy-related acute leukaemia in mitoxantrone-treated multiple sclerosis patients. Presented at the 25th Congress of the European Committee for the Treatment and Research in Multiple Sclerosis (ECTRIMS), Sept 11, 2009. Poster 825. PubMed
Martinelli V, Capra R, Cocco P, et al. High incidence of acute leukaemia in multiple sclerosis patients treated with mitoxantrone: a retrospective multicentre Italian study. Presented at the 25th Congress of the European Committee for the Treatment and Research in Multiple Sclerosis (ECTRIMS). Sept 11, 2009. Poster 824.PubMed
Zephir H, de Seze J, Duhamel A, et al.Treatment of progressive forms of multiple sclerosis by cyclophosphamide: a cohort study of 490 patients. J Neurol Sci. 2004;15;218:73-77.PubMed

Howard L. Zwibel, MD
Howard L. Zwibel, MD
Medical Director, Multiple Sclerosis Center at Doctors Hospital
Coral Gables, FL


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