Abstract
Primary progressive multiple sclerosis (MS) is primarily a neurodegenerative phenotype
of MS. It is characterized by a predominant progressive disease course that largely
determines the disability progression rather than the rare early superimposed relapses.
Therefore, frustratingly, the immunomodulatory and immunosuppressive approaches have
failed to have any meaningful impact on the disability progression in primary-progressive
MS. Some benefit can still be obtained in select patients where notable number of
superimposed relapses or significant ongoing subclinical magnetic resonance imaging
activity may allow for immunomodulatory agents to work. Symptomatic treatment for
MS should also not be overlooked in this population for impact on quality of life.
Future work will likely focus more on the remyelinating and regenerative strategies
to help this group of patients. Unfortunately, the lack of any warning symptoms hampers
any future prevention trial in this population. However, inferring from previous studies
in secondary progressive MS, a global effort to eliminate initiation of tobacco smoking
in teenagers or young adults may also delay the onset of a progressive disease course
in MS.
Keywords
primary progressive multiple sclerosis - cigarette smoking - treatment - glatiramer
acetate - interferon beta-1a - methotrexate - cladribine - rituximab
