An Overview of High-Efficacy Drugs for Multiple Sclerosis: Gulf Region Expert Opinion

Abstract

This article discusses the opinions of the multiple sclerosis (MS) experts in the Gulf region on the use of high-efficacy disease-modifying drugs (DMDs; natalizumab, fingolimod, alemtuzumab, cladribine tablets, and ocrelizumab) in clinical practice. The experts reviewed the current literature including pivotal clinical trials and meta-analyses for high-efficacy DMDs, supplemented by the expert opinions on the usage of these DMDs in clinical practice. Several criteria were discussed by the panel based on different efficacy, safety, and convenience attributes. The panel concluded that all the DMDs available for the treatment of MS have benefits and risks, which should be considered while discussing the treatment plan with the patient. It is important to have a personalized approach based on the risk-benefit assessment for each case. Common considerations while choosing treatments include effectiveness, side effects/safety, and convenience/route of administration. Funding : Merck Serono Middle East FZ LTD.

Family Planning for People with Multiple Sclerosis in Saudi Arabia: an Expert Consensus

“…Recent years have seen a considerable expansion in the number of DMDs available for the management of RRMS. Among currently available indicated for therapeutic use in people with RRMS, alemtuzumab, cladribine tablets, fingolimod, natalizumab, and ocrelizumab are considered high-efficacy DMDs, usually reserved for use in patients with a history of higher disease activity [ 19 ]. The labelling of DMDs in Europe (Summary of Product Characteristics) and US (Prescribing Information) does not provide rules for prescribing that are mandatory in KSA, but they do provide useful sources of information on the level of risk to a pregnancy associated with them.…”

Cladribine Tablets and Relapsing–Remitting Multiple Sclerosis: A Pragmatic, Narrative Review of What Physicians Need to Know

“…Cladribine tablets 3.5 mg/kg is contraindicated in this setting, and precautions to prevent pregnancy must be maintained for at least 6 months after treatment (of either partner), although its efficacy persists well beyond this period, with no additional treatment needed for several years in most patients after the treatment course in the second year. Our aim in this review was to provide pragmatic recommendations for the administration of cladribine tablets as a relatively new therapeutic option for the management of MS. A detailed account of the relative efficacy and tolerability/safety of this agent is beyond the remit of this review, and the reader is referred to other sources for this information [34,35]. One network meta-analysis (of 44 studies that evaluated 12 DMDs) compared cladribine tablets with other DMDs in people with MS [34].…”

Expert consensus from the Arabian Gulf on selecting disease-modifying treatment for people with multiple sclerosis according to disease activity

“…The efficacy, tolerability, and safety of DMDs have been reviewed extensively elsewhere [5,12]. For the purposes of this article, discussion of the properties of individual DMDs will be brief, and Table 1 provides a brief overview of their administration, efficacy, and safety [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32].…”

“…DMDs approved for the management of relapsing-remitting MS (RRMS) are often classified into broad groups. 'First-line' or 'platform' agents usually refer to interferons, glatiramer acetate, and teriflunomide, while 'highefficacy' agents usually include fingolimod, alemtuzumab, natalizumab, ocrelizumab, and cladribine tablets [5,12]. Dimethyl fumarate may be intermediate between these categories, as there is some evidence that the efficacy of this agent is similar to that of fingolimod [33,34].…”