WILLIAM STUART, MD: When picking a drug for combination therapy in MS, you look for one that's well tolerated, that doesn't have a high level of side effect. You try and identify one that may work in a different way from the primary drug that you're using, so that you can intrude on the immune responses in more than one way. Or if you need a very strong suppression of the disease, you'll use a drug that broadly suppresses the immune system and control that suppression, such as in the use of mitoxantrone or Cytoxan. It's a careful balance between effectiveness and side effect ratios that the drugs may have.

In our center we've been using combinations of drugs for probably seven or eight years or longer. But all of the first-line drugs will work very well with steroids. So steroids you can combine with almost anything in combination. And that's what we consider to be our second level of treatment.

At a third level of treatment there are several oral agents: methotrexate; Imuran; there's a drug called CellCept, which is used in the transplant field that -- all three of these drugs are successfully combined with first-line drugs. And small studies have been done and are being done to demonstrate their effectiveness.

FREDERICK MUNSCHAUER, MD: When talking about combinations of drugs or drugs to add to either interferons or Copaxone for the treatment of multiple sclerosis, it's important to recognize that none are currently approved by the FDA. In fact, we have no level one clinical evidence, the results of randomized controlled clinical trials, that shows that any combination of drugs is more effective than treating MS than the monotherapies currently available, interferons and Copaxone.

Having said that, the majority of neurologists are quite comfortable adding drugs such as steroids, particularly methylprednisolone, to interferons or Copaxone in order to try to achieve better control of MS disease activity. There is a wealth of experience that this combination -- adding on steroids -- is both safe and effective in treating MS.