Disease-modifying drugs for multiple sclerosis: a rapid and systematic review.

Mantel's extension of Mantel-Haenzel procedure * Used only in tables and appendices 1. Prevention of disease progression and relapse rates. This is the aim of the disease modifying (or immunomodulatory) drugs. The drugs examined in this report are: azathioprine, beta interferon (IF), cladribine, cyclophosphamide, glatiramer, intravenous immunoglobulin, methotrexate and mitoxantrone. Azathioprine is licensed for use in all forms of MS. IF-1a and 1b are licensed for use in relapsing-remitting MS and secondary progressive MS, and IF-1b is licensed for use in secondary progressive MS. Cladribine, cyclophosphamide, glatiramer, intravenous immunoglobulin, methotrexate and mitoxantrone are not licensed in the UK for use in MS. 2. Treatment of acute exacerbations. Steroids are the treatment for acute worsening of symptoms or new neurological disturbances that do not spontaneously resolve. Steroids reduce the severity of the exacerbation but do not affect consequent disability. 3. Treatment of chronic symptoms -such as spasticity by physiotherapy and antispasticity drugs, and fatigue by psychological and physiological treatments, and by neurorehabilitation. 1. Prevention of disease progression and relapse rates. This is the aim of disease-modifying (or immunomodulatory) drugs; these are considered in this report. 2. Treatment of acute exacerbations. Steroids are the treatment for acute worsening of Chapter 1