(FDA approved in bold)

• Reduction of relapses in patients with relapsing forms of multiple sclerosis (relapsing-remitting or secondary progressive with relapses)
  
• Clinically isolated syndromes (CIS)

• By modifying the immune processes believed responsible in part for the development of MS. Interferon-beta has antiviral and immunomodulatory activities. Produces multiple gene products and markers, including beta-2 microglobulin, that affect immune function

• At least 6 months

• Continue to use

• Repeat brain MRI, check for neutralizing antibodies, change to glatiramer, reconsider the diagnosis of relapsing MS, and consider using natalizumab or mitoxantrone

• Acute attacks are often treated with glucocorticoids, especially if there is functional impairment such as vision loss, weakness, or cerebellar symptoms
  
• Treat common clinical symptoms in MS with appropriate medication for spasticity (baclofen, tizanidine), neuropathic pain, and fatigue (modafinil)
  
• For patients with relapsing MS refractory to interferon-beta, as measured by clinical outcome and MRI accumulation of lesions, consider changing to glatiramer, natalizumab, or mitoxantrone. Other options, which are less proven, include monthly methylprednisolone, pulse cyclophosphamide, and other immunosuppressants
  
• Combination therapy may have a role, but has not been proven more effective than monotherapy. There is an ongoing clinical trial looking at combination treatment with interferon 1a (Avonex) and glatiramer acetate (Copaxone). Using interferon-beta with natalizumab may increase risk of progressive multifocal leukoencephalopathy

• None required