Beginning of the end of two-stage theory purporting that inflammation then degeneration explains pathogenesis of progressive multiple sclerosis

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Abstract

Purpose of review

The review discusses future directions in research on multiple sclerosis and neuromyelitis optica, as long-held beliefs about these diseases are undermined with data from recent clinical trials.

Recent findings

Results of clinical trials for registration (phase 3) were reported in the last year. Anti-inflammatory approaches, such as daclizumab high-yield process targeting IL-2 receptor, and ocrelizumab targeting CD20 B cells, confirmed a beneficial role of immune suppression in relapsing–remitting disease. And now for the first time achieving the primary end point in primary progressive multiple sclerosis was attained with ocrelizumab.

Summary

The results in the past year challenge the long-held belief that relapsing–remitting disease is inflammatory, whereas progressive forms of the disease are ‘less inflammatory’ and more ‘degenerative.’

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