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Controversies in Neurology |

Not Every Patient With Multiple Sclerosis Should Be Treated at Time of Diagnosis

Sean J. Pittock, MD; Brian G. Weinshenker, MD; John H. Noseworthy, MD; Claudia F. Lucchinetti, MD; Mark Keegan, MD; Dean M. Wingerchuk, MD; Jonathan Carter, MD; Elizabeth Shuster, MD; Moses Rodriguez, MD
Arch Neurol. 2006;63(4):611-614. doi:10.1001/archneur.63.4.611.
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Disease-modifying agents approved for treatment of patients with multiple sclerosis (MS) are glatiramer acetate, interferon beta-1b and -1a, and mitoxantrone hydrochloride. Natalizumab was Food and Drug Administration approved in November 2004, but the manufacturers suspended marketing and clinical trials in 2005 because of safety concerns. Interferon beta-1a is approved for individuals with clinically isolated syndromes (CISs) who are at relatively high risk to “convert to MS.”15 Opinions vary about whom and when to treat. On one hand, the Medical Advisory Board of the National Multiple Sclerosis Society consensus statement (updated in February 2005) recommends initiation of a disease-modifying agent “as soon as possible following definite diagnosis of MS with a relapsing course, and in selected patients with first attack who are at high risk for MS (CIS).”6 Alternatively, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines suggest “it is appropriate to consider” treatment with approved therapies in these patients.1

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