b'MS, but should be thought of as symptomatic improvement that showed in 49.9 percent oftherapies. patients at two years. Additionally, patient healthAs with any therapy, the benets have to related quality of life and capacity for work,be weighed against the risks. These drugs improved.At the two-year point data analysis,may only be eective for about 40 percent of showed that of those who began natalizumabpeople with MS. Typically, a four-week trial treatment less than three years after thewill let you know if the drug is going to improve diagnosis, 44.4 percent attained overall noyour symptoms. These drugs should not be evidence of disease activity measures and noused by people with a history of seizures or MRI evidence of disease activity measures.kidney impairment. 4-AP is signicantly cheaper OnenoteisthattheMRIfollow-upsonlythan dalfampridine, but may not be covered looked at white matter lesions and there mayby insurance as it is not FDA-approved. be some correlation between treatments andnew grey matter lesions but not white matterNatalizumab shows improvements lesions. It was also observed that patients whohalfway through clinical trial had minimal to no disability at the beginningA clinical trial sponsored by Biogen published of treatment had better results at two years.a two-year interim analysis of the results. The The article was published in BMC Neurology.trial began in February 2012 and was completed Dr. Thrower:We currently have 19 FDA-approvedin November 2018, as researchers recruited disease modifying therapies to help changeat 47 sites in the United States. Study participants the course of MS. All of these therapies canreceived 300 mg intravenous natalizumab be judged based on their eectiveness, safetyevery four weeks prescribed by their treating and convenience.physician.Success is dened by achieving overall There are two ways we can think aboutcondition with no evidence of disease activity choosing a DMT. One treatment paradigmin both clinical and no MRI evidence of has been termed escalation therapy. Thisdisease activity measures. Two hundred would mean choosing a therapy with modestthirty-one patients were enrolled in STRIVE ecacy, but great safety as a rst option. Ifand because of various reasons from screenings, the patient has breakthrough MS activity onwithdrawal of consent, or life changes, the that choice, we would then move to a moreevaluation numbers vary for the results. effective therapy. The alternative to thisResearchers at Weill Cornell Multiple Sclerosis paradigm has been called induction therapy.Center, Cleveland Clinic, Northwestern Here, we go to a more eective therapy as aUniversity, and New York University School of rst option, realizing that this choice mayMedicine found that 72.4 percent of participants come with a higher risk of side eects.maintained no clinical evidence of disease One could argue that Tysabri (natalizumab)activity. 61.5 percent of participants maintained is one of our most eective treatment options.no MRI evidence of disease activity measured. In the STRIVE study, people with MS diagnosedOther aspects of the review looked at cognitive within the last three years were placed on53 msfocusmagazine.org'