[Practical advice for a safe, effective and well tolerated therapy of multiple sclerosis]

This article provides practical advice how to improve safety, efficacy and tolerability of disease-modifying treatment for multiple sclerosis. The dosage of interferon-beta preparations should be gradually increased during the first weeks of therapy to ameliorate flu-like adverse effects. Analgesics, taken 30 minutes before injection, may alleviate these symptoms a well as injection-associated pain. Correct injection technique, an autoinjector and injection site rotation help to improve skin tolerance. Leukopenia or hepatotoxicity may develop after years of trouble-free therapy. Blood count and liver enzymes should therefore be regularly monitored. With glatiramer acetate, a disturbing but harmless systemic postinjection reaction may occur which should be explained to the patient at the beginning of therapy. Azathioprine is potentially hemato- and hepatotoxic. Transaminases and differential blood count should be frequently checked to ensure the correct dosage. Mitoxantrone is potentially cardiotoxic. An electrocardiogram recording and transthoracic echocardiography should be performed twice a year throughout therapy. With all of these drugs, effective contraception must be used, in particular with mitoxantrone and azathioprine.