Damage to the myelin sheath and axon ensue due to several distinct molecular mechanisms (Fig. 1) [1, 2]: first, a primary autoimmune response may result in damage to the complex of the myelin sheath and axon by (i) autoantibody and complement-mediated damage by macrophages and microglia, (ii) cytokine-mediated damage and (iii) cytotoxic damage by CD4+ and CD8+ T cells. Second, CHIR99021 given an altered sensitivity of the immune system, primary damage to the myelin sheath or axons may trigger a secondary immune response. In addition to the proinflammatory, pathogenic effects of T and B cells, distinct subsets of these immune cells exert protective anti-inflammatory effects such as the release

of neurotrophic factors and immunosuppressive cytokines. Disease-modifying immunotherapy approaches have provided great advances in the management of disorders such as MS Doxorubicin manufacturer or CIDP. Within the context of common pathogenic mechanisms, this review aims to summarize common or divergent clinical effects of disease-modifying treatment options across both disorders. This may deepen our understanding of the disease mechanism of each, and may assist with selecting the best treatment for each disorder. As corticosteroids and plasma exchange are used predominantly to treat relapses and are not assumed to exert disease-modifying effects in both disorders,

they are not the subject of this review. A detailed discussion of these treatment modalities can be found elsewhere [3-7]. Preparations and applications: in clinically isolated syndrome (CIS) and RRMS, immunomodulation with recombinant IFN-β-1a [8-14], 1b [12-18] or GA [12, 19-21] serves as basic therapy, which should be initiated as soon as possible after the diagnosis has been clonidine properly established. In addition, recombinant IFN-β may also be used in SPMS with residual inflammatory activity. Four preparations are available in Europe and the United

States for the treatment of MS patients with recombinant IFN-β (IFN-β-1a: Avonex®, Rebif®; IFN-β-1b: Betaferon®/Betaseron®, Extavia®). IFN-β-1b (Betaferon®/Betaseron®, Extavia®) is injected subcutaneously (s.c.) at a dose of 8 million IU every other day. IFN-β-1a is available in two different preparations: IFN-β-1a (Avonex®) is injected intramuscularly (i.m.) at a dose of 6 million IU (30 μg) once per week. IFN-β-1a (Rebif®) is injected subcutaneously at a dose of 22 μg or 44 μg thrice weekly. Clinical trials: very recent data have emerged from a Phase III clinical trial that evaluated the 1-year efficacy and safety of peginterferon beta-1a in patients with RRMS. In this global, multi-centre, randomized, double-blind, parallel-group, placebo-controlled study (ADVANCE), more than 1500 patients with RRMS received either pegylated IFN-β-1a (125 μg) administered by s.c.