Combination therapy

So far, off-label recommendation of a combination therapy is mainly based on phase II study evidence and on largely accepted expert opinions. Combination therapy represents a new, more global strategy, to increase the possible benefits with the combined use of already available disease-modifying therapies or with other new agents, having an acceptable theoretical rationale and a good safety and efficacy profile. The therapeutic strategies of the near future will try to select among different and individualised combinations of drugs, with distinct mechanisms of action, and possibly with synergistic activity, to maximise benefits and minimise risks. The combination approach is at present particularly recommended for more aggressive forms of multiple sclerosis (MS) and for non-responders to available drugs, although the theoretical rationale and accumulated experience would suggest its use in all MS patients right from the beginning of the disease.