Talk:Management of multiple sclerosis

message: Wikipedia:Scientific peer review/recent reviews
I have asked for scientific peer-review of this article. I would appreciate any ideas to improve or to correct any mistakes there may be. --Garrondo 08:40, 1 September 2007 (UTC)
thread_title: Scientific peer-review

message: It's a good idea to off-load this article. Thanks for doing it! InvictaHOG 19:16, 28 October 2006 (UTC)
thread_title:  A good idea 

message: After a whole month working in the article I think I have finished improving it. I have added more than 60 references, reordered much of it and moved some information very similar to lists to secondary articles. I think is a much better article than a month before. Therefore I'm thinking of nominating it for "good article"; however it may be difficult to get it becouse it doesn't have any pictures. The problem is that I can't think of any pictures that fit. Any ideas? Does anybody think it has some possibilities?
--Garrondo 14:22, 31 August 2007 (UTC)
replies: text: May I suggest the structure of mitoxantrone? There is no published crystal structure of natalizumab, although that would look cool :) :Image:Methylprednisolone.svg might be appropriate for "Management of acute attacks". Structure images are usually a good idea when there is nothing more appropriate. Fvasconcellos (t·c) 15:21, 2 September 2007 (UTC)
thread_title: Finished my clean up

message: I have nominated the article as a good article candidate. I would be thankful to anybody who who helped in the good article review (See: Wikipedia:Good article candidates
If you have not contributed significantly to this article, feel free to evaluate it according to the good article criteria and then pass or fail the article as outlined on the candidates page. 
--Garrondo 13:27, 5 September 2007 (UTC)
thread_title: [[Therapies for multiple sclerosis]] good article candidate

message: In consideration of the 500,000+ hits on Google when searching for tai chi and multiple sclerosis, I think it behooves those looking to create a comprehensive, GA-status article to do some investigating and potentially include a mention. It would seem that many published works also touch upon the practice as an MS therapy, as do more scholarly sources. VanTucky Talk 23:29, 12 September 2007 (UTC)
thread_title:  Alternative therapy 

message: This article is very well written, with relatively easy to understand prose, and sufficient reference citations. It has a good, well-written, lead section, and good use of images. As written, I beliee this article meets the Good Article criteria, and will be listed.
A couple of areas of improvement: first, the section headers seem to be kind of long and wordy. Perhaps they could be reduced or paraphrased a bit. Although they do seem to be an accurate description of their contents, so I'm not sure how to go about reducing them. Maybe something as simple as combining the 'management of...' headers into one main section, with subsections, would reduce the repetition of the 'management of...' line, making it a bit easier to read?
Second, under 'Management of relapsing-remitting MS', the second to last paragraph, dealing with ease of use, price and side effects, is unsourced. As some information on the frequency of injections is provided, a reference should be added (though, given the well-sourced nature of the article as a whole, I won't withhold GA status over this one issue). I think that the earlier references for the drugs, a few paragraphs up, probably have this information anyway, so they could be used here.
I like the look of the chemical structure of methylprednisolone, and compared to the structure of mitoxantrone, the lines used in the structure of the latter are much weaker and less apparent than the former. Perhaps the structure of mitoxantrone could be improved a bit in the 
image file to use darker lines, and maybe increasing the size of the image just a bit, so more closely match the look of methylprednisolone.
Also, a suitable image for the upper right-hand corner, to be used as an intro, would help to better grab the attention of the reader. I don't think an infobox is needed here, but a good lead image would be nice.
Hope this helps improve the article even more! Good work so far! Dr. Cash 21:03, 18 September 2007 (UTC)
replies: text: Sticking my nose in—I've created a new structure of mitoxantrone to match the methylprednisolone one. Fvasconcellos (t·c) 02:14, 19 September 2007 (UTC)
thread_title: GA Review

message: I have nominated the article for featured article after working on it after it become a GA. If you think the article is good enough please vote for it. Any comments for improvement will also be welcomed.Garrondo 13:41, 25 October 2007 (UTC)
thread_title: Featured article

message: I would suggest moving this page to Treatment of multiple sclerosis, consistent with articles such as Treatment of Crohn's disease, Treatment of bipolar disorder and others. If nobody objects I will go ahead and rename the article. --WS (talk) 23:33, 16 November 2007 (UTC)
replies: text: Done. --WS (talk) 19:49, 19 November 2007 (UTC)
thread_title: Rename to [[Treatment of multiple sclerosis]]

message: "Some studies also show benefits on physical variables" ... what the heck does that mean?  Isn't there a more straightforward way of saying it? Leotohill (talk) 05:53, 24 January 2008 (UTC)
thread_title:  benefits on physical variables 

message: I can't quite figure out this sentence:
"After some years, many of the people who have this subtype begin to experience neurologic decline without acute relapses as the secondary progressive subtype. "
I've spent several minutes here trying to write up what it might mean, without success. What is it that is the "secondary progressive subtype"?  What is it secondary to?  Are there other secondary types that are not progressive?
Call me confused.  24.39.174.1 (talk) 14:31, 24 January 2008 (UTC)
replies: text: The desription of the "secondary progressive subtype" is indeed accurate, as it is the usual consequence of un-treated RRMS. "Are there other secondary types that are not progressive?" Answer is No, but there are progressive forms that are not "secondary"....io-io (talk) 00:46, 10 March 2008 (UTC)
thread_title:  confusing sentence in intro 

message: Im a little shocked that BVT (bee venom therapy) has not been brought up, especially considering the success stories with them. 
Bee Venom Therapy at Discovery
ODNation (talk) 01:54, 25 January 2008 (UTC)
replies: text: A part of the article you mention: Given the fact that no major studies on BVT have been done so far: if there are no scientific articles on topic to mention it in the wikipedia article is not an option--Garrondo (talk) 09:06, 25 January 2008 (UTC)
replies: text:  I have found only one randomized trial in pubmed on bee venom therapy and multiple sclerosis and does not support its use. I have added this information to the article. Please next time search for credible sources before proposing editions.--Garrondo (talk) 09:33, 25 January 2008 (UTC)
thread_title:  Bee Venom Therapy? 

message: A pennsylvania doctor has recently found a cure for ms that has not yet been widely accepted.  He uses fluconazol and a 2 week no sugar diet to treat patients.  He has cleared a whole wing of a hospital which dealt with MS by using this treatment.  I am friends with one of his patients who could not walk but within a few months of seeing this doctor she went trick or treating with her kids
someone should post this  —Preceding unsigned comment added by 141.152.238.229 (talk) 15:40, 25 January 2008 (UTC)
replies: text: Sure...please provide facts... Miracles don´t exist but there is plenty of bussiness in trying to sell them.--Garrondo (talk) 15:51, 25 January 2008 (UTC)
replies: text: After search on Fabulini: it does not even appear in google... not to mention scientific articles. Probably it does not even exist. Its the result of appearing in main page... I´m looking forward to ending this pain...agggggggggggggggggggggggg.  --Garrondo (talk) 17:21, 25 January 2008 (UTC)
replies: text: Well, you did want people to read the article, right? :) GeeJo (t)⁄(c) • 17:45, 25 January 2008 (UTC)
thread_title: doctor fabulini

message: :::After some research, and still some more to do for some of the minor scores, here is the "RELATIVE EFFECTIVENESS" table I was proposing to add. I would welcome ALL comments (from ANYONE) before doing so. . Thank You.
 RELATIVE EFFECTIVENESS OF APPROVED DISEASE-MODIFYING TREATMENTS FOR MS
Medical Name                                                                                             	Brand Name          	Safety limits long-term use	Dosing Schedule                  	Lesion Reduction	Advantage (2 years) in Lesion Reduction	Relapse Reduction	Advantage (2 years) in Relapse Reduction	Disability Progression Reduction	Advantage (2 years) in Disability Progression
Glatiramer acetatehttp://www.themcfox.com/multiple-sclerosis/ms-drugs/copaxone/copaxone-effectiveness.htm	Copaxone            	No                         	1 x day subcutaneous injection   	Yes             	Vs placebo                             	Yes              	29% vs placebo                          	No                              	n/a
Interferon beta-1a                                                                                       	Avonex              	No                         	1 x week intramuscular injection 	Yes             	                                       	Yes              	29% vs placebo                          	Yes                             	37% vs placebo
Interferon beta-1a                                                                                       	Rebif               	No                         	3 x week subcutaneous injection  	Yes             	80% vs placebo                         	Yes              	27% vs placebo                          	Yes                             	Vs placebo
Interferon beta-1b                                                                                       	Betaseron/ Betaferon	No                         	1 x 2 days subcutaneous injection	Yes             	80% vs placebo                         	Yes              	34% vs placebo                          	No                              	n/a
Mitoxantrone                                                                                             	Novantrone          	Yes                        	1 x 3 months infusion            	Yes             	Vs placebo                             	Yes              	Vs placebo                              	Yes                             	Vs placebo
Natalizumabhttp://www.emea.europa.eu/humandocs/PDFs/EPAR/tysabri/H-603-PI-en.pdf                         	Tysabri             	No                         	1 x month intravenous infusion   	Yes             	96% vs placebo                         	Yes              	68% vs placebo                          	Yes                             	54% vs placebo
:::Comments Received on my TALK page (from Garrondo) which will be incorporated -
::Wow...you have done a great work. It´s a great improvement to the article. 
I only have some minor improvements:
*I don`t like the colur use, specially the blue for letters, since they seem internal links. I would rather prefer black as in all articles. Yellow might also be too strong
*I would add internal links to medications, type of injections, and any other word difficult to understand
*I would also writte completely sub-cutaneous, since just sub-c would not be understood by some non medical readers. DONE
*I would eliminate the "?" after safety limits... In no other title you have added it. DONE
*I suppuse v is versus. Im not english, but, is it not better understood as vs? DONE
*Interferon 1-b is betaseron in US, but betaferon in all Europe, both names should appear.DONE
*Add all the refs with diberris tool: http://diberri.dyndns.org/wikipedia/templates/ to continue with the format used in the articleDONE
:::All Other Comments and/or Input (some data is sitll missing) by Anyone are most Welcome.... io-io (talk) 15:06, 4 March 2008 (UTC)
replies: text: Thanks - those changes are great! The quantities of relapse reduction have been for many years the normal "primary endpoint" of MS trials (it used to be just lesion counts, but they are difficult to measure perfectly and the correlation with clinical benefit is not great), as it was previously thought that 2 years might be a tough time-frame in which to prove an advatange in limiting disability, which is of course the "primary issue" with MS...io-io (talk) 00:17, 8 March 2008 (UTC)
replies: text: Hi io-io, I know nothing about pharmacology etc , and I realize that you have done a look of work on this.  I do however wonder if this level of detail in necessary or desirable in an encyclopedia entry. Is it the sort of thing mooting at various medical and pharmacology project pages, just to see what others think? Maybe it is just me.  I am quite happy to be overruled --Slp1 (talk) 23:01, 7 March 2008 (UTC)
replies: text: Hi Slip...you will see if you scroll up that this discussion was started in January, and the table borne out of it - I mean why compare side-effects and administration route, if not efficacy...especially when MS patients are be-set with all sorts of nonsense about therapies ranging from nutrition and zen to stem-cell treatments in 3rd-world countries...in fact all DMD drugs work to some extent, it is established...io-io (talk) 00:17, 8 March 2008 (UTC)
replies: text: I think that treatment of multiple sclerosis is alredy an specific article, (there is alredy a multiple sclerosis general article) so information can get to much more specific level of detail. The difference about the different treatments are really difficult to explain so a table like this one is the best method from my point of view to give this information. The main aim is not to give information for medical workers (and thats the reason why I eliminated the quantities of product given) but to give information for a general reader (who of course would be probably very interested in MS due to different reasons) on the efficacy of the different medications. I think its a good improvement to the article.--Garrondo (talk) 10:03, 8 March 2008 (UTC)

text: Yes this is indeed much simpler and better. Maybe instead of "No" we should write "No Proof" or "Un-Proven" or simply "Not Shown". The reason I had earlier specified a dosage strength for Betaferon and Rebif is partly in strict conformance with the trial results, and partly because a higher dose for Rebif (44mg) is available, but is only occasionally used (poor tolerability and risk to liver) - and I know that it's scores were almost identical to the main 22mg dose anyway, so it hardly matters. Your choice of colours is also appropriate to the tone. I have not had much time to edit Wiki (I want to research the missing scores), but will perhaps this evening or tomorrow. Thanks again....io-io (talk) 16:29, 8 March 2008 (UTC)
replies: text: No need to give thanks... You have been the one doing the hardest job. I proocceed to say "Not shown", and of course it can be improved with your research of the missing scores... but right now I believe its good enough to load it to the main article and improve it there... Feel free to do it. The honour of doing it should be yours. :-) --Garrondo (talk) 17:22, 8 March 2008 (UTC)
replies: text: Finished data, added explanatory Notes...important to distinguish between RRMS and its "later" or advanced form SPMS in data, as this largely defines actual treatment use....io-io (talk) 00:39, 10 March 2008 (UTC)

text: This is maybe the best we can do - I had been trying, not to make the rows deeper, but to make the 2 efficacy columns wider, at least relative to the dosing schedule column, which was looking very wide. Hmmm...perhaps we could add back a "lesion reduction" column and simply put "YES" in each box...But in any case, I agree that we don't want to make the box any "deeper" (longer) than it is now.....io-io (talk) 13:52, 11 March 2008 (UTC)
replies: text: I agreed with you when you eliminated the lesion reduction column and I don´t think there are any problem on dosing schedule being widther than other columns (at least is much prefereable to rows becoming deeper. Right now as I alredy posted in your talk page the only thing to do is to add the references you name in the notes section to its corresponding comment. --Garrondo (talk) 14:30, 11 March 2008 (UTC)

text: Great - exactly what I was trying to do in the first place, but my asterisks (*) were turning into bullet-points...we can probably put it on the Wiki tomorrow....io-io (talk) 21:00, 10 March 2008 (UTC)
replies: text: No mention of LDN or CCSVI here. Low dose natrexone works on my MS, and CCSVI has gotten people out of wheelchairs. These may be sepaate articles, and if so, they ought to be linked.46.7.165.130 (talk) 16:28, 10 January 2012 (UTC)
thread_title: Relative effectiveness

message: I prefer this design
:This is maybe the best we can do - I had been trying, not to make the rows deeper, but to make the 2 efficacy columns wider, at least relative to the dosing schedule column, which was looking very wide. Hmmm...perhaps we could add back a "lesion reduction" column and simply put "YES" in each box...But in any case, I agree that we don't want to make the box any "deeper" (longer) than it is now.....io-io (talk) 13:52, 11 March 2008 (UTC)
replies: text: I agreed with you when you eliminated the lesion reduction column and I don´t think there are any problem on dosing schedule being widther than other columns (at least is much prefereable to rows becoming deeper. Right now as I alredy posted in your talk page the only thing to do is to add the references you name in the notes section to its corresponding comment. --Garrondo (talk) 14:30, 11 March 2008 (UTC)

text: Great - exactly what I was trying to do in the first place, but my asterisks (*) were turning into bullet-points...we can probably put it on the Wiki tomorrow....io-io (talk) 21:00, 10 March 2008 (UTC)
replies: text: No mention of LDN or CCSVI here. Low dose natrexone works on my MS, and CCSVI has gotten people out of wheelchairs. These may be sepaate articles, and if so, they ought to be linked.46.7.165.130 (talk) 16:28, 10 January 2012 (UTC)
thread_title: last version table

message: "Patients with PPMS have also been included in trials of . . . cladribine. However, no treatment in these trials has been shown to modify the course of the disease."
Should this be updated in light of this ? Jh39 (talk) 22:13, 30 April 2009 (UTC)
thread_title:  Cladribine 

message: I agree with Polarlys that the use of :Image:Cannabis sativa.jpg in Treatment of multiple sclerosis #Alternative treatments is problematic and raises WP:WEIGHT issues. Cannabis doesn't have good evidence for MS; it would be better to give an image of an alternative treatment that is better supported by scientific evidence (vitamin D, for example). Better yet would be an image specific to MS, rather than some stock shot of a plant or a pill. Eubulides (talk) 07:37, 8 June 2009 (UTC)
replies: text: Ok, I won't revert again. Feel free to remove it and add a new image.--Garrondo (talk) 13:40, 8 June 2009 (UTC)
thread_title:  Cannabis image 

message: There are some additional new therapies approved.  DGG ( talk ) 00:53, 16 December 2012 (UTC)
thread_title: updating needed

message: My name is Florian Schaub at Merck KGaA. My aim is to make some changes in this article, because we have identified some misleading information. I have provided clearly arranged suggestions that you can see below on the talk page. They all follow the same pattern:
• Current Version
• Suggested Revision (Suggested changes are bold)
• Reason
• Suggested Reference (if needed)
Please let me know if anyone has concerns.
_Current Version:
“Newer treatments feature intravenous (IV) infusions (shown above) at 1 to 3-month intervals.”
Suggested Reviosion:
“Treatments feature intravenous (IV) infusions (shown above) at 1- to 12-month intervals, and oral drugs, taken daily or twice-daily.”
Reason 1:
IV treatments have been used for many years, while newer treatments tend to focus on the oral route of administration. 
Reason 2:
We have suggested the change to the treatment interval as Lemtrada infusions are administered 12 months apart.
Reference 1: Multiple Sclerosis (MS). Treatment. http://www.multiplesclerosis.com/us/treatment.php [Accessed 03 Jun 2016].
Reference 2: Lemtrada US product label
_Current Version:
As of November 2014, nine disease-modifying treatments have been approved by regulatory agencies of different countries…”
Suggested Reviosion:
As of June 2016, 14 disease-modifying treatments have been approved by regulatory agencies of different countries…”
Reason:
Updated for June 2016.
Reference: 
National Multiple sclerosis society. Medications. http://www.nationalmssociety.org/Treating-MS/Medications [Accessed 03 Jun 2016].
_Current Version:
“…and the Japanese Pharmaceuticals and Medical Devices agency (PMDA).”
Suggested Revision:
We suggest changing the link URL to: https://en.wikipedia.org/wiki/Pharmaceuticals_and_Medical_Devices_Agency
Reason:
The current link directs to an incorrect page.
_Current Version:
“Interferon beta-1a is injected either weekly (intramuscular injection) or three times a week (subcutaneous injection) depending on commercial formulations, while interferon beta-1b is injected subcutaneously every second day.”
Suggested Revision:
“Interferon beta-1a is injected, either weekly (intramuscularly), three times a week or every other week (subcutaneously) depending on the commercial formulation, while interferon beta-1b is injected subcutaneously every second day.”
Reason:
Suggested text to account for Plegridy injections, which are administered every other week.
Suggested Reference:
US and EU Rebif, Avonex, Plegridy and Betaferon product labels
_Current Version:
“Another oral drug, cladribine, was approved in Russia and Australia in 2010. Its application was rejected by the FDA and EMEA in 2011 due to safety concerns in spite of the promising efficacy of the drug. This led the pharmaceutical to discontinue commercialization and withdraw all marketing applications.”
Suggested Revision:
“Another oral drug, cladribine, was approved in Russia and Australia in 2010. Its application was rejected by the FDA and EMEA in 2011 due to safety concerns, in spite of the promising efficacy of the drug. This led the pharmaceutical company to discontinue commercialization and withdraw all marketing applications. Merck KGaA announced its intention to submit cladribine for EU approval in September 2015, following additional data which allowed a better characterization of cladribine’s benefit–risk profile.”
Reason:
The current text is out of date.
Suggested Reference:
Cladribine press release: http://www.merckgroup.com/en/media/extNewsDetail.html?newsId=1C517A71C016A43BC1257EBC006B50C3&newsType=1
_Current Version:
“PML is an opportunistic infection with neurological progressive symptoms caused by the replication of the JC virus in the glial cells of the brain. All 3 initial cases were taking natalizumab in combination with interferon beta-1a. After a safety review the drug was returned to the market in 2006 as a monotherapy for MS under a special prescription program. As of May 2011, over 130 cases of PML had been reported, all in patients who had taken natalizumab for more than a year. While none of them had taken the drug in combination with other disease-modifying treatments, previous use of MS treatments increases the risk of PML between 3 and 4-fold. The estimated prevalence of PML is 1.5 cases per thousand natalizumab users. Around 20% of MS patients with PML die, while most of the remaining are importantly disabled.”
Suggested Revision:
“Soon after its approval, natalizumab was withdrawn from the market by its manufacturer after it was linked with three cases of the rare but hazardous neurological condition called progressive multifocal leukoencephalopathy (PML). PML is an opportunistic infection with neurological progressive symptoms caused by the replication of the John Cunningham (JC) virus in the glial cells of the brain. In all three initial cases, patients were taking natalizumab in combination with interferon beta-1a. After a safety review the drug was returned to the market in 2006 as a monotherapy for MS under a special prescription program. As of September 2014, there were 495 confirmed cases of PML. While none of them had taken the drug in combination with other disease-modifying treatments, previous use of MS treatments increases the risk of PML between 3- and 4-fold. The estimated prevalence of PML is 1.5 cases per thousand natalizumab users.[23] Around 20% of MS patients with PML die, while most of the remaining are importantly disabled.”
Reason:
We suggest the addition of this source, as it the most recent data showing the number of patients receiving Tysabri who have developed PML.
Suggested Reference:
https://www.bostonglobe.com/business/2014/10/22/biogen-idec-reports-death-patient-that-had-taken-its-multiple-sclerosis-pill-tecfidera/xrAtOBsxA7eHZN3BB0phxJ/story.html
_Current Verison:
“Teriflunomide is considered a very safe drug.”
Suggested Revision:
“Teriflunomide is also subject to warnings in the US for hepatotoxicity and risk of birth defects if used during pregnancy.”
Reason:
The US prescribing information contains a black box warning for hepatotoxicity and teratogenicity. The paragraph goes on to say “there have been reports of liver failure, and PML. Teriflunomide is also known to be dangerous for fetal development”. It is contradictory to include this information and claim that teriflunomide is a safe drug.
Suggested Reference:
US Aubagio product label
_Current Version:
“Moreover, fumaric acid is also used to treat psoriasis, another autoimmune disorder, and there is long term safety data from over 14 years of use without any indication of further dangerous secondary effects.”
Suggested Revision:
“Moreover, fumaric acid is also used to treat psoriasis, another autoimmune disorder, and there is long-term safety data from over 14 years of use. However, four cases of PML have been observed in patients treated with Tecfidera.”
Reason:
To include information on the risks associated with fumaric acid esters.
Suggested Reference:
US and EU product labels
http://www.medscape.com/viewarticle/856148
_Current Version:
“Natalizumab and mitoxantrone are considered highly effective both in terms of relapse rate reduction and halting disability progression…”
Suggested Revision:
“Natalizumab and mitoxantrone are considered highly effective, both in terms of relapse rate reduction and reduction of disability progression…”
Suggested Reference:
Kornek B, Patient Prefer Adherence 2015; 9: 675–84
Martinelli Boneschi M et al. Cochrane Database Syst Rev 2013; 5: CD002127
_Current Version:
“While some believe that they will probably reduce the usage of first-line treatments the long-term safety of interferons and glatiramer acetate will probably slow this trend. It has been recommended that at the moment oral treatments should be mainly offered in those cases where patients do not use existing treatments due to needle phobia or other reasons such as perceived inefficacy of interferons and glatiramer acetate.”
Suggested Revision:
“While some believe that they will probably reduce the usage of first-line treatments, the long-term safety of interferons and glatiramer acetate will probably slow this trend. Oral treatments may be attractive in cases where patients do not use existing treatments due to needle phobia or for other reasons such as perceived inefficacy of interferons and glatiramer acetate.”
Reason:
We have suggested removing the first sentence, as it was not supported by the reference.
The reference has been misquoted – it does not recommend oral treatments for any patient group. This change will bring the text in line with the reference used.
_Current Version:
“Dimethyl fumarate is potentially one of the most interesting oral drugs due to the long term data from use in psoriasis which points towards a very good safety profile.”
Suggested Revision:
“Dimethyl fumarate is potentially one of the most interesting oral drugs due to the long-term data from use in psoriasis, which distinguishes it from fingolimod, teriflunomide and laquinimod.”
Reason:
The reference gives a number of common AEs related to DMF treatment initiation. Gastrointestinal events and flushing are described as very common in the EU and US regulatory labels for this drug, and  4 cases of PML have been reported in MS patients taking DMF (with additional cases n patients taking DMF for other indications). We therefore feel that it is perhaps inaccurate to say that it has a very good safety profile. However, the reference does state that long term safety data distinguishes DMF from a number of drugs, and so the text has been suggested to reflect this.
_Current Version:
“Studies on the use of Interferon-beta-1b in secondary progressive and progressive relapsing MS do not support that it slows progression of the disease, although it is effective in reducing the number of relapses.”
Suggested Revision:
“Studies show that interferon beta-1b slows disability progression in relapsing secondary progressive MS, but not in non-relapsing secondary progressive and progressive relapsing MS, although it is effective in reducing the number of relapses.
Studies show a difference in time to disability progression between interferon beta-1a and placebo in a subgroup of secondary progressive MS patients with relapses, but not in the whole patient population.”
Reason:
Information suggested to clarify the impact of interferon beta-1b in SPMS.
Content suggested to include information on interferon beta-1a.
Suggested Reference:
Betaferon EU label
SPECTRIMS Study Group. Neurology 2001; 56:1496–1504
US and EU product labels
_Current Verison:
Therapies under investigation [section header]
Suggested Revision:
Suggest removing all references to alemtuzumab from the section.
Reason:
Alemtuzumab is now approved for treatment of MS.
_Current Version:
Such is the case the PEGylated version of interferon-β-1a, that has a longer life than normal interferon and therefore it is being studied if given at less frequent doses has a similar efficacy than the existing product. With the completion of a robust two-year study, it is shown that the PEGylated interferon beta-1a has greater efficacy in decreasing relapse rate and disability progression compared to placebo for MS patients.
Suggested Revision:
Suggest moving this section from the ‘Therapies under investigation’ section to the ‘Medications’ section.
Reason:
PEGylated interferon beta-1a has been approved for treatment of MS, and thus is no longer under investigation.
--Florian Schaub at Merck KGaA (talk) 16:00, 08 July 2016 (UTC)
thread_title: Factual Corrections 

message: Hello fellow Wikipedians,
I have just modified 3 external links on Management of multiple sclerosis. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:
*Added archive https://web.archive.org/web/20130228120500/http://www.pharma.us.novartis.com/cs/www.pharma.us.novartis.com/product/pi/pdf/gilenya.pdf to http://www.pharma.us.novartis.com/cs/www.pharma.us.novartis.com/product/pi/pdf/gilenya.pdf
*Added archive https://web.archive.org/web/20110724094302/http://www.hta.ac.uk/execsumm/summ427.htm to http://www.hta.ac.uk/execsumm/summ427.htm
*Added archive https://web.archive.org/web/20150621082446/https://www.rcplondon.ac.uk/sites/default/files/documents/multiple-sclerosis-guideline.pdf to https://www.rcplondon.ac.uk/sites/default/files/documents/multiple-sclerosis-guideline.pdf
When you have finished reviewing my changes, you may follow the instructions on the template below to fix any issues with the URLs.
Cheers.—InternetArchiveBot (Report bug) 08:09, 13 October 2017 (UTC)
thread_title:  External links modified 

message: My name is Florian Schaub from Merck KGaA. My aim is to make some changes in this article because we have found some misleading information. I've compiled the suggested changes which you can find herinafter. They all follow one pattern:
• Current text
• Suggested revision
• Reason
• Suggested reference
If someone has objections please let me know.
_Current text
Disease-modifying treatments are expensive and most require frequent (up-to-daily) injections, under the skin or into the muscle.
_Suggested revision
Disease-modifying treatments are expensive compared with therapies that only help ease MS symptoms (e.g. medications for pain, fatigue and muscle spasms). Most require frequent (ranging from every day to every 4th week) injections (under the skin [subcutaneous], into the muscle [intramuscular] or into veins [intravenous]), or oral treatment.
_Reason
To clarify what the costs of DMTs are compared to and to accommodate the range of treatment frequencies.
_Suggested reference
“Disease-Modifying Therapies for MS”  https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-The-MS-Disease-Modifying-Medications.pdf. Updated May 2017           
_Current text
Newer treatments feature intravenous (IV) infusions (shown above) at 1 to 3-month intervals.
_Suggested revision
Treatments feature intravenous infusions (shown above) at 1- to 12-month intervals, and oral drugs, taken once- or twice-daily. 
_Reason
IV treatments have been used for many years, while newer treatments tend to focus on the oral route of administration.
The change to treatment interval was suggested as Lemtrada® infusions are administered 12 months apart.
_Suggested reference
Multiple Sclerosis (MS). Treatment. https://www.multiplesclerosis.com/us/treatment.php [Retrieved on 18 July 2017].
Lemtrada® US Prescribing Information. Genzyme Corporation (July 2016). http://products.sanofi.us/Lemtrada/Lemtrada.pdf [Retrieved on 18 July 2017]
_Current text
Interferon beta-1a is injected either weekly (intramuscular injection) or three times a week (subcutaneous injection) depending on commercial formulations,[15][16] while interferon beta-1b is injected subcutaneously every second day.[17]
_Suggested revision
Interferon beta-1a is injected either weekly (intramuscular injection) or three times a week (subcutaneous injection) depending on commercial formulations,[15][16] while interferon beta-1b is injected subcutaneously every second day.[17][18]
_Reason
References are from 2007 and may contain out of date information. More recent references with more up to date information are suggested. 
_Suggested reference
[15] Avonex® US Prescribing Information. Biogen, Inc. (March 2016). https://www.avonex.com/content/dam/commercial/multiple-sclerosis/avonex/pat/en_us/pdf/Avonex%20US%20%20Prescribing%20Information.pdf [Retrieved on 18 July 2017]
[16] Rebif® US Prescribing Information. EMD Serono, Inc. (November 2015). http://emdserono.com/ms.country.us/en/images/Rebif_PI_tcm115_140051.pdf?Version [Retrieved on 18 July 2017] 
[17] Betaseron® US Prescribing Information. Bayer HealthCare Pharmaceuticals, Inc. (April 2016). http://labeling.bayerhealthcare.com/html/products/pi/Betaseron_PI.pdf [Retrieved on 18 July 2017]
[18] Extavia® US Prescribing Information. Novartis Pharmaceuticals Corporation (May 2016). https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/extavia.pdf [Retrieved on 18 July 2017]
_Current text
Another oral drug, cladribine, was approved in Russia and Australia in 2010. Its application was rejected by the FDA and EMEA in 2011 due to safety concerns in spite of the promising efficacy of the drug. This led the pharmaceutical to discontinue commercialization and withdraw all marketing applications.[31]
_Suggested revision
On 25th August 2017, Merck Serono Europe announced that the European Commission (EC) granted marketing authorization for MAVENCLAD® 10 mg (Cladribine Tablets) for the treatment of highly active RMS in the 28 countries of the European Union (EU) in addition to Norway, Liechtenstein and Iceland [1].
_Reason
To update text and provide up-to-date references in line with Wikipedia style (i.e. no original research articles).
_Suggested reference
[1] European Commission Grants Approval for Mavenclad (Cladribine Tablets) http://ec.europa.eu/health/documents/community-register/2017/20170822138481/dec_138481_en.pdf  [Accessed 01 September 2017]
TYSABRI® (natalizumab): PML in Patients Receiving TYSABRI (USA TYSABRI PML Update). Biogen, Inc. (21 June 2017). https://medinfo.biogen.com/secure/download?doc=workspace%3A%2F%2FSpacesStore%2Fded9df8f-d785-444a-ae89-888bef72aa7e&type=pmldoc&path=null&dpath=null&mimeType=null [Retrieved on 18 July 2017]
_Current text
As of May 2011, over 130 cases of PML had been reported, all in patients who had taken natalizumab for more than a year.[25] 
_Suggested revision
As of 6 June 2017, there have been 731 confirmed PML cases (728 patients being treated for MS, 3 patients treated for Crohn’s disease). The number of natalizumab doses prior to PML diagnosis ranged from 8 to 134, with a mean treatment duration of 49 months.
_Reason
We suggest the addition of this source, as it is the most recent data showing the number of patients receiving Tysabri® who have developed PML.
_Suggested reference
TYSABRI® (natalizumab): PML in Patients Receiving TYSABRI (USA TYSABRI PML Update). Biogen, Inc. (21 June 2017). https://medinfo.biogen.com/secure/download?doc=workspace%3A%2F%2FSpacesStore%2Fded9df8f-d785-444a-ae89-888bef72aa7e&type=pmldoc&path=null&dpath=null&mimeType=null [Retrieved on 18 July 2017]
_Current text
During clinical trials fingolimod gave rise to side effects such as hypertension and bradycardia, macular edema, elevated liver enzymes or reduction in lymphocite levels
_Suggested revision
During clinical trials fingolimod gave rise to side effects such as hypertension and bradycardia, macular edema, elevated liver enzymes or reduction in lymphocyte levels
PML has also been reported under fingolimod treatment since marketing authorisation
_Reason
Corrected the spelling of lymphocyte
We suggest the additional information from the EU SmPC to reflect the cases of PML, with additional reference
_Suggested reference
Gilenya® EU Summary of Product Characteristics. Novartis. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002202/WC500104528.pdf [Retrieved on 07 August 2017]
_Current text
Teriflunomide is considered a very safe drug. Nevertheless, there have been reports of liver failure, and PML. Teriflunomide is also known to be dangerous for fetal development.
_Suggested revision
Teriflunomide is also subject to warnings in the US for hepatotoxicity and birth defects if used during pregnancy.
_Reason
The US Prescribing Information contains a black box warning for hepatotoxicity and teratogenicity. It is contradictory to include this information and claim that teriflunomide is a safe drug. 
_Suggested reference
Aubagio® US Prescribing Information. Genzyme Corporation (November 2016). http://products.sanofi.us/aubagio/aubagio.pdf [Retrieved on 18 July 2017]
_Current text
Moreover, fumaric acid is also used to treat psoriasis, another autoimmune disorder, and there is long term safety data from over 14 years of use without any indication of further dangerous secondary effects.[28]
_Suggested revision
Moreover, fumaric acid is also used to treat psoriasis, another autoimmune disorder, and there is long-term safety data from over 14 years of use. [28] However, PML has been observed in patients treated with dimethyl fumarate.
_Reason
To include information on the risks associated with fumaric acid esters.
_Suggested reference
Tecfidera® US Prescribing Information. Biogen, Inc. (January 2017). https://www.tecfidera.com/content/dam/commercial/multiple-sclerosis/tecfidera/pat/en_us/pdf/full-prescribing-info.pdf [Retrieved on 18 July 2017]
_Current text
Treatment with interferons or glatiramer acetate after an initial attack decreases the risk of developing clinical definite MS.[5][38]
_Suggested revision
Treatment with interferons or glatiramer acetate after an initial attack decreases the risk of developing clinical definite MS.[5][38] However, no oral treatments have been licensed for treatment of CIS. 
_Reason
Suggestion made for clarity regarding treatment options for CIS.
_Current text
While some believe that they will probably reduce the usage of first-line treatments the long-term safety of interferons and glatiramer acetate will probably slow this trend.[28] It has been recommended that at the moment oral treatments should be mainly offered in those cases where patients do not use existing treatments due to needle phobia or other reasons such as perceived inefficacy of interferons and glatiramer acetate.[28]
_Suggested revision
While some believe that they will probably reduce the usage of first-line treatments, the long-term safety of interferons and glatiramer acetate will probably slow this trend.[28] Oral treatments may be attractive in cases where patients do not use existing treatments due to needle phobia, or for other reasons such as perceived inefficacy of interferons or glatiramer acetate.[28]
_Reason
The reference does not recommend oral treatments for any patient group. This change will bring the text in line with the reference used.
_Current text
Dimethyl fumarate is potentially one of the most interesting oral drugs due to the long term data from use in psoriasis which points towards a very good safety profile.[28]
_Suggested revision
Dimethyl fumarate is potentially one of the most interesting oral drugs due to the long term data from use in psoriasis, which distinguishes it from fingolimod, teriflunomide, and laquinimod.[28]
_Reason
The reference gives a number of common adverse events related to dimethyl fumarate treatment initiation. Gastrointestinal events and flushing are described as very common in the EU and US regulatory labels for this drug, and 4 cases of PML have been reported in MS patients taking DMF. It may be inaccurate to say that it has a very good safety profile. However, the reference does state that long-term safety data distinguish DMF from a number of drugs, and the suggested text reflects this.
_Current text
Studies on the use of Interferon-beta-1b in secondary progressive and progressive relapsing MS do not support that it slows progression of the disease, although it is effective in reducing the number of relapses.[47]
_Suggested revision
Studies show that interferon beta-1b decreases the number of relapses in relapsing-remitting and secondary progressive MS, and in one study it slowed disability progression in secondary progressive MS.[1][2] 
In patients with relapsing-remitting MS, one study has shown a difference in time to disability progression between those treated with interferon beta-1a and those treated with placebo. [3]
_Reason
Information suggested to clarify impact of interferon beta-1b in SPMS.
Content suggested to include information on interferon beta-1a.
_Suggested reference
[1] Extavia® US Prescribing Information. Novartis Pharmaceuticals Corporation (May 2016). https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/extavia.pdf [Retrieved on 18 July 2017]
[2] Betaferon® EU Summary of Product Characteristics. Bayer Global Pharma AG (April 2017). http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000081/WC500053225.pdf [Retrieved on 18 July 2017]
[16] Rebif® US Prescribing Information. EMD Serono, Inc. (November 2015). http://emdserono.com/ms.country.us/en/images/Rebif_PI_tcm115_140051.pdf?Version [Retrieved on 18 July 2017] 
_Current text
Research [section header]
_Suggested revision
Suggest removing all references to alemtuzumab (once in text, and the image of the structure of alemtuzumab) and daclizumab. Both drugs are now approved for treatment of MS
_Reason
Factual correction.
_Current text
Such is the case the PEGylated version of interferon-β-1a, that has a longer life than normal interferon and therefore it is being studied if given at less frequent doses has a similar efficacy than the existing product.[136][137] With the completion of a robust two-year study, it is shown that the PEGylated interferon beta-1a has greater efficacy in decreasing relapse rate and disability progression compared to placebo for MS patients.[138]
_Suggested revision
Suggest moving this to the “Medications” section, as PEGylated interferon beta-1a has been approved for treatment of MS.
_Reason
Factual correction.
--Florian Schaub at Merck KGaA (talk) 13:37, 18 October 2017 (UTC)
thread_title:  Announcement of Changes 

message: Hello fellow Wikipedians,
I have just modified 2 external links on Management of multiple sclerosis. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:
*Added archive https://web.archive.org/web/20130512021453/http://www.biogenidec.com/press_release_details.aspx?ID=5981&ReqId=1801165 to http://www.biogenidec.com/press_release_details.aspx?ID=5981&ReqId=1801165
*Added archive https://web.archive.org/web/20131004220459/http://www.biogenidec.com/press_release_details.aspx?ID=5981&ReqId=1777510 to http://www.biogenidec.com/press_release_details.aspx?ID=5981&ReqId=1777510
*Added  tag to http://www.biogenidec.com/press_release_details.aspx?ID=14712&Action=1&NewsId=2368&PID=61997
When you have finished reviewing my changes, you may follow the instructions on the template below to fix any issues with the URLs.
Cheers.—InternetArchiveBot (Report bug) 18:46, 31 December 2017 (UTC)
thread_title:  External links modified 

message: As can be seen in the Featured version, the citation style used in this article was the long-standing and well established Diberri format, vancouver style authors, more than five authors truncated to three.  I have restored, per WP:CITEVAR, and to make it easier to edit without having to work around endless unused citation template parameters.  SandyGeorgia (Talk)  06:41, 6 September 2020 (UTC)
thread_title:  CITEVAR breach repaired 

message: This article is a 2007 FA that has not been maintained to standard.  Many sections have become listy and taken on WP:PROSELINE, the Research section (and possibly more) is outdated, there are numerous maintenance tags, there are copyedit issues, there is WP:CITATION OVERKILL on non-controversial statements, some of the sections are poorly organized and contain information that would better belong in a History section, Further reading needs to be pruned or content added to article, and there are MOS issues like faulty dashes/hyphens and incorrect use of italics and bolding. Unless someone can restore this article to standard, it should be submitted to Featured article review.  SandyGeorgia (Talk)  00:20, 10 November 2020 (UTC)
thread_title:  Featured article review needed 

message: Based on prior advice, I think it would be conflict of interest for me to add it, but I wanted to flag that there are a couple of recent sources that relate to updated evidence for treatments and comparisons between treatments: 
Gonzalez-Lorenzo M, Ridley B, Minozzi S, Del Giovane C, Peryer G, Piggott T, Foschi M, Filippini G, Tramacere I, Baldin E, Nonino F. Immunomodulators and immunosuppressants for relapsing‐remitting multiple sclerosis: a network meta‐analysis. Cochrane Database of Systematic Reviews 2024, Issue 1. Art. No.: CD011381. DOI: 10.1002/14651858.CD011381.pub3. Accessed 10 January 2024.
Tramacere I, Virgili G, Perduca V, Lucenteforte E, Benedetti MD, Capobussi M, Castellini G, Frau S, Gonzalez-Lorenzo M, Featherstone R, Filippini G. Adverse effects of immunotherapies for multiple sclerosis: a network meta‐analysis. Cochrane Database of Systematic Reviews 2023, Issue 11. Art. No.: CD012186. DOI: 10.1002/14651858.CD012186.pub2. Accessed 10 January 2024.
The WHO also recently added treatments for MS (rituximab, glatiramer acetate and cladribine) to the Essential Medicines List for the first time, not sure the right source type for this, but here's the announcement:  https://www.who.int/news/item/26-07-2023-who-endorses-landmark-public-health-decisions-on-essential-medicines-for-multiple-sclerosis  — Preceding unsigned comment added by YetiHed (talk • contribs) 13:49, 10 January 2024 (UTC)
thread_title:  Relevant Cochrane and other sources