Current status of multiple sclerosis therapy in Germany: a national survey

We conducted a semi-standardized enquiry concerning diagnostic, immunotherapeutic and supportive care strategies for multiple sclerosis (MS). A questionnaire was sent to all German neurological departments in December 1996, with 63% (n = 244) responding before May 1997. As might be expected, MS therapy in Germany is not very standardized. Most clinics use intravenous steroids for treating relapses, although with different dosing regimens. Nevertheless, oral steroids are also used. Interferon-beta and azathioprine are both used for the treatment of relapsing-remitting MS at the same frequency. Only 33% of German neurological departments said that they used an immunomodulating agent for chronic-progressive cases, indicating it in about 50% of cases. Azathioprine is the drug of first choice, followed by methotrexate. Regarding supportive care measures, the technique of intermittent self-catheterization is widely under-represented. Despite the lack of conclusive evidence from prospective studies for the value of azathioprine, it is still one of the most commonly used drugs for the treatment of relapsing-remitting and chronic-progressive MS. There was no evidence of a consensus on treatment standards for chronic-progressive disease courses.