Conclusions and Future Prospects

The last 10 years have seen an important step forward in the effort to find effective treatments for MS: the successful development of the first generation of clinically effective disease modifying agents (e.g., interferons and glatiramer acetate). These agents were developed as immunomodula-tory drugs, and they are effective at reducing inflammation and relapse rate (which is a clinical manifestation of acute inflammation). They have not been as successful in preventing the development of nonremitting disability (Kappos et al., 2001; Cohen et al., 2002).

Axonal degeneration appears to be a major contributor to disability in MS, and with renewed interest in neuronal/ axonal destruction, there exists a therapeutic opportunity and urgent clinical need for the development of neuropro-tective agents for MS. Although only some of the molecules reviewed in this chapter have the high clinical index needed for translation into the clinical realm, most of them contribute to proof-of-principle, and a number of agents in this chapter are being considered for clinical trial evaluation. The development of neuroprotective agents, which may complement immunomodulatory drugs, is a promising mul-tipronged strategy that may provide clinicians and patients with new therapeutic tools that will slow or prevent progressive neurological impairment in MS.

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