Distúrbios Imunológicos e Imunoterapia
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The "Efficacy Approach": Infusion Therapies in the Treatment of Relapsing-Remitting Multiple Sclerosis

William Heuser, Cheng-Hsiao Tai, Michael Harrington and Christopher Giacalone

Multiple sclerosis (MS) is among the most common causes of neurological disability in young adults. As an immune-mediated inflammatory demyelinating disease of the central nervous system (CNS), treatment is aimed at decreasing the rate of relapse and slowing the accumulation of brain lesions on MRI readings. A number of immunemodulatory treatments are currently available that effectively reduce the relapse rate, however they are not curative. An algorithm presently exists, but the choice of specific agent should be individualized according to disease activity, patient values, and preferences. This review will focus on the use of infusion therapies that have been studied for the treatment of relapsing-remitting multiple sclerosis (RRMS). Natalizumab and Alemtuzumab have been studied extensively in phase III clinical trials and are considered to be highly effective for the treatment of RRMS. In comparison, mitoxantrone, which is an immunomodulary agent used in relapsing-remitting and progressive forms of MS, has limitations due to the risk for cardiac toxicity and limited evidence of clinical benefit. Infusion therapies with Natalizumab and Alemtuzumab have truly changed the treatment of RRMS and their significant advantages and benefits should not be discounted.