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Escalating Immunotherapies for Highly Active Multiple Sclerosis: Reviewing the Evidence

Antonio Scalfari, MD1, Richard Nicholas, PhD, FRCP2, Omar Malik, PhD, FRCP2, and Paolo A Muraro, MD, PhD1,2

Multiple sclerosis (MS) is an inflammatory demyelinating disorder of the central nervous system [1,2] that results in marked axonal degeneration and gliosis in the advanced stages. However, quantitative microscopic studies have shown that there can be prominent loss of axons within active lesions even in early phases of the disease [3,4]. Clinical features are heterogeneous and long-term prognosis is difficult to predict. The majority of patients experience an initial disease phase that is punctuated by exacerbations and remissions (relapsing–remitting phase; RRMS) followed, in approximately 80% of cases, by progressive accumulation of disability (secondary progressive phase; SPMS) [5]. Approximately 15–20% of patients present with a progressive course from the onset (primary progressive; PPMS) [6].

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