Wednesday, August 22, 2012
For the treatment of choice or therapeutic method to prevent and must be based on a symptom of the disease or on objective data to prove its safety and effectiveness are based.
However, there are several levels of evidence. Only to be confirmed by a neighbor on the effectiveness of a medicine (evidence) is very weak evidence. The same statement from a large number of people are certainly more weight, but is still far from conclusive evidence that a particular approach has its supporters, although its usefulness is questionable goal.
The fact that treatment will be used for many years, even centuries, is not conclusive evidence of their effectiveness. Just think of the bloodshed, which was practiced thousands of years ago, but we now know to be dangerous and even deadly, because it weakens the already sick patient. However, since a long time this practice is effective and was used widely since ancient times to the twentieth century.
This last point is important because many drugs that act on the nervous system or immune system, including potentially serious side effects. Difficulty in MS is that, as is often remissions almost complete in the early stages of the disease, and that the intervals between outbreaks varies greatly (these intervals 30 years in some cases exceeded), it is very difficult to know what If the improvement of the clinical situation, which lasted for several years because of the effect of treatment or the occurrence of natural remission.
The minutes of the study double-blind placebo-controlled clinical study designed to provide a solution to this problem, both in medical and surgical care and rehabilitation for the treatment of "alternative". Another problem is the enormous cost pressure in the treatment of some new drugs. Economy is becoming increasingly important in the evaluation of therapeutic, and in spite of the discussions that were raised by the institution.
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So far, we have evaluated the progress made in treatment, to change the course of the disease. But breakthroughs have been equally important in the last decade in the treatment of neurological symptoms and rehabilitation. Is the development of new drugs and new methods of management of drug-old. Has been confirmed by controlled studies on certain aspects of the rehabilitation of the nervous system also the effectiveness of this method in the treatment of MS
Evidence of the effectiveness and choice of treatment
As with other serious diseases, the clinical phenotype is highly variable, and there are two main problems in MS, which affects all aspects of treatment. First, the effectiveness of treatment is difficult to determine, it is not easy to prove that the potential beneficial effects for the treatment of a greater chance of having side effects.
Here, we must stress the very problem that the success of these approaches in the past few years. Clinical studies have shown that it is possible, in the course of the disease by two categories of drugs currently approved, or at least change in some countries: in the beta interferons and acetate glatiramer. We now know that this treatment is effective in part, is no longer justified, morally, to provide a large scale and over long periods of placebo-controlled clinical studies so far have been necessary to shed light on the effectiveness of new drugs.
While it may be of shorter duration studies are justified morally, but will not be useful to study chronic disease such as MS. Another strategy would be to compare the new therapy to treat the list, but such a study would provide results much more difficult to interpret and will be more expensive than the trials and placebo-controlled. Therefore, we must develop a new approach to clinical trials, and this is exactly the goal of international cooperation, carried out under the auspices of the International Federation of Multiple Sclerosis.
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