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Unfortunately Mitoxantrone Is Associated With Cardiotoxicity At Higher Doses ...

Unfortunately mitoxantrone is associated with cardiotoxicity at higher doses so its use in MS is questionable and it has also been noted that its long term effects are not yet proven and any effects are mainly in the short term (Murray 2006).
Corticosteroids
Corticosteroids are used to treat the relapses common in MS. Indeed they were the only useful treatment until the arrival of the interferons in the mid 1990s (Neuhaus, Kieseier & Hartung 2006) and methyprednisolone remains the treatment of choice and most widely used option to treat acute attacks (Murray 2006).
Corticosteroids work by reducing the inflammatory response but have no effect on reducing the agents causing the inflammatory response. Thus they are effectively a palliative option only, dealing with the symptoms but not the cause. In addition, as corticosteroids reduce the whole immune response, they leave patients open to infection, which can greatly impair recovery from MS relapses.
Natalizumab
Natalizumab is a novel immunoregulatory agent which was believed to offer hope in the treatment of MS. Natalizumab is a monoclonal antibody that acts against a2-integrin, a adhesion molecule involved in T-cell migration through the blood brain barrier (Senior 2005). Unfortunately it has been found to be associated with progressive multifocal leucoencephalopathy, which can be fatal. Indeed, in one trial of natalizumab one patient did die as a result of the development of multifocal leucoencephalopathy, but it was found that she did not in fact have MS. It was more likely that she suffered from serious migraines that brought on similar clinical symptoms to MS. Nonetheless it has resulted in natalizumab undergoing a safety update, which includes all previous patients who have received the drug (Senior 2005). However this case has highlighted the need for stricter diagnoses prior to enrolment onto clinical trials for new MS agents (Langer-Gould, Steinman 2006).
Cannabinoids
Cannabis and the cannabinoid family of drugs are believed to have a therapeutic potential in MS, due to the effects of endocannabinoids on reducing inflammation in vivo. Up to 4% of UK MS patients are believed to use cannabis for symptom relief (Zajicek et al. 2003).
A review of trials to date indicated that whilst earlier trials showed a greater effect on spasticity and tremor, as well as in improving the subjective feelings associated with MS; the more recent trials have not replicated these results (Ben Amar 2006). One example is the three year cannabis in MS (CAMS) trial of more than 600 patients, which found that there was no clear benefit to using cannabis to treat MS, specifically the spasticity symptoms often anecdotally benefiting from cannabis use (Zajicek et al. 2003).

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