Providing Evidence-based Oral Health Care to Individuals Diagnosed with Degenerative Disorders, Part 1: Multiple Sclerosis
Medications to Modify the Course of Disease

The underlying etiology of MS has been widely disputed within the research community. Some researchers consider MS an autoimmune, inflammatory disease.³² Others, however believe MS is a chronic metabolic disorder or that it is a neurodegenerative disease by which the body’s autoimmune response is reacting to neurodegenerative debris.^33,34 Regardless of the how researchers view the etiology of the disease, they all agree it is linked to autoimmune activity. This involvement has driven the treatment options available today.

Since 1993 the U.S. Food and Drug Administration (FDA) has approved ten disease modifying medications for the treatment of RRMS. These medications have been shown to reduce the number of relapses/exacerbations, decrease the number of new lesions formed, and conceivably slow the progression of disease. Table 3 outlines dosing, warnings, and common side effects of the disease modifying therapies approved by the FDA. Nine of the therapies are considered first line therapies. Five of the first line therapies are dispensed by injection, three are dispensed orally, and one is dispensed by IV. Tysabri (natalizumab), the therapy dispensed by IV, is generally reserved for people who see no results from or cannot tolerate other types of treatments. This is a monoclonal antibody was approved for marketing by the FDA in 2004; however, in 2005 the manufacturer voluntarily suspended marketing of the therapy after several reports of significant adverse events. In 2006 the therapy was again approved by the FDA under strict treatment guidelines. Novantrone® (mitoxantrone) is the only therapy not considered a first line. This immunosuppressant therapy is approved for individuals with progressing forms of RRMS (those whose RRMS is progressing in despite of treatment with a first-line medication), SPMS, and PRMS.^35,36 Due to potential cardiac events and leukemia Novantrone® is rarely administrated to people with MS.