Treatment of progressive multiple sclerosis: review of the problem
Clinical trials have generally found only limited or no effectiveness for the available treatments of patients with secondary and primary progressive multiple sclerosis. Despite these obstacles, therapeutic decisions must be made. According to the results of multiple researches following recommendations could be concluded. The chance to achieve атн positive effect is higher in cases of younger patients (less than 40-50 years) with less then one year progression course of multiple sclerosis and active enhanced lesions on brain MRT. There are some kinds of treatment that could be used in clinical practice: intravenous glucocorticoid monthly pulses (more often methylprednisolone 1000 mg per month), intravenous mitoxantrone every three months, cladribine intravenous or subcutaneous, intravenous cyclophosphamide and glucocorticoid monthly pulses. The final decision about the therapy should be based on dates about individual contraindications, age, sex, birth planning and informative agreement of the patient. From all discussed drugs only ocrelizumab (a humanized anti-CD20 monoclonal antibody) influences on rate of brain atrophy. It's registration and future investigation will trigger clear understanding of progressive multiple sclerosis pathogenesis and will help discover another effective kinds of treatment.