Les traitements de première ligne dans la sclérose en plaques

Immunomodulatory drugs (Interferon beta and glatiramer acetate) are widely used as first-line treatment for relapsing remitting multiple sclerosis (RRMS). Several products are marketed world wide, and biosimilar products are emerging. Immunosuppressors (mitoxantrone, natalizumab and fingolimod) can be also used as up-front treatment in Europe considering very strict clinical and radiological criteria. Immunomodulators, used as a first-line treatment in multiple sclerosis, reduce relapse rates by about 1/3, reduce the appearance of new MRI lesions by about 2/3. Some studies have shown reduced disability progression, and reduced rates of brain atrophy. This review succinctly summarizes clinical effects, issues related to immunogenicity, and impact of immunomodulators response. It relates tolerance and toxicity results and proposes important unresolved issues for future research.