To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
More closely analogous to the use of combination therapies in multiple sclerosis (MS) is the use of combination therapies in autoimmune diseases such as rheumatoid arthritis. In the case of MS, drugs could be directed at different therapeutic domains such as tissue destruction and tissue repair. Currently, natalizumab is approved only as a monotherapy. This is due to concern over combined toxicity because of the two cases of progressive multifocal leukoencephalopathy (PML) that occurred in patients enrolled in the combination arm of the SENTINEL trial. Perhaps the most frequently used combination therapy approach utilized in clinical practice for patients with relapsing-remitting MS and continued disease activity while on platform therapy is the ad hoc addition of periodic courses of corticosteroids, most often intravenous methylprednisolone. This chapter discusses cytotoxic therapies and combination trials with other immunomodulating agents such as daclizumab, terilunomide and statins.
Terilunomide is being investigated in a comprehensive program of clinical trials in patients with multiple sclerosis (MS) with relapses and in patients with a clinically isolated syndrome (CIS). This program evaluates the efficacy and safety of terilunomide on a range of clinical and magnetic resonance imaging (MRI) end-points when administered either as monotherapy or as an adjunctive therapy to ongoing treatment with conventional disease-modifying therapies (DMTs). Clinical data indicates that terilunomide is generally well tolerated with an acceptable safety profile, with no significant safety concerns identified to date. Safety data from the open-label extension phase of the study are consistent with the safety profile of terilunomide observed in the double-blind treatment phase, without the emergence of any new safety concerns. Based on currently available data on monotherapy and adjunctive therapy, terilunomide appears to have a favorable benefit/risk ratio in relapsing MS, and as such, represents a promising new first-line treatment.
Email your librarian or administrator to recommend adding this to your organisation's collection.