Benefits versus risks of latest therapies in multiple sclerosis: a perspective review

Abstract

Disease-modifying treatments for multiple sclerosis (MS) have now been available for almost 20 years. Interferon β (IFN-β) products and glatiramer acetate (GA) were the first available options and are now considered first-line agents for the treatment of MS. These medications have several years of favorable safety data, but are not effective in completely controlling disease activity in all patients. Alternate medications with increased efficacy have been developed and identified; however, these newer medications have known or potential safety concerns which have prompted clinicians to view them as second-line agents. Highly efficacious and safe medications are continuously being searched for and developed; however, time is needed to establish the long-term safety of any new therapeutic agent. MS practitioners are faced with the clinical dilemma of treating patients with very safe modestly effective medications or using more efficacious and potentially riskier agents. The risk-benefit profile of every medication will have to be weighed carefully and clinicians will need to gage the risk tolerance of each patient in order to tailor treatment. This review will summarize benefits and risks of recently approved therapies in MS and will provide a perspective view on the placement of these medications within the MS treatment algorithm in the near future.

Vitamin D in Multiple Sclerosis and Central Nervous System Demyelinating Disease—A Review

“…Approximately 15% of patients accumulate neurological disability with or without superimposed relapses from the onset of their condition (1,2). Although the realm of therapeutics has evolved dramatically (5,6), neuroprotective treatments remain elusive in MS. Recently, vitamin D has gained attention as a potential adjuvant therapy that seems to reduce MS risk and ameliorate disease severity.…”

Brief Review and a Clinical Case of Hemolytic Uremic Syndrome Associated with Interferon β Treatment

“…In particular, cases of TMA manifesting as TTP or HUS have been reported with INFβ products; this side effect may occur after several years of therapy. In addition, TMA has been described with different INFβ formulations including intramuscular INFβ-1a, sc INFβ-1a, and sc INFβ-1b [26] . Complete blood count and liver function test are recommended at 1, 3, and 6 months following the initiation of the therapy and periodically thereafter.…”

Safety of Newer Disease Modifying Therapies in Multiple Sclerosis

“…Other complications included CMV reactivation in the first 6 weeks of treatment, pulmonary aspergillosis, HSV/HHV-6 infection, and reactivation of pulmonary tuberculosis [ 162 , 163 , 164 ]. There was also a report of Guillain–Barré syndrome in a patient on alemtuzumab for T-cell-prolymphocytic leukemia [ 165 , 166 ]. Given the high risk profile of alemtuzumab in terms of safety, the EMA recommended restricting the use of alemtuzumab to patients with highly active RRMS who have failed at least two DMTs [ 167 ].…”