Disease‐modifying treatments for multiple sclerosis – a review of approved medications

Abstract

Background and purposeThere is still no curative treatment for multiple sclerosis (MS), but during the last 20 years eight different disease-modifying compounds have been approved for relapsing−remitting MS (RRMS).MethodsA literature search was conducted on published randomized controlled phase III trials indexed in PubMed on the approved medications until 21 May 2015.ResultsIn this review the mode of action, documented treatment effects and side effects of the approved MS therapies are briefly discussed.ConclusionsBased on current knowledge of risk−benefit of the approved MS medications, including factors influencing adherence, it is suggested that oral treatment with dimethyl fumarate or teriflunomide should be preferred as a starting therapy amongst the first-line preparations for de novo RRMS. In the case of breakthrough disease on first-line therapy, or rapidly evolving severe RRMS, second-line therapy with natalizumab, fingolimod or alemtuzumab should be chosen based on careful risk−benefit stratification.

Critical Appraisal of Effectiveness of Oral Fingolimod on Relapsing Multiple Sclerosis

“…Many injectable DMTs and oral agents are available for use in MS (Longbrake et al, 2016). DMTs include IFN-β-1a, IFN-β-1b, glatiramer acetate, teriflunomide, dimethyl fumarate (as the first line medications), mitoxantrone, alemtuzumab, natalizumab, and fingolimod (as the second line medications) (Torkildsen et al, 2015).…”

Multiple Sclerosis

“…Genelde 14 mg lık doz tercih edilmektedir. TEMSO ve TOWERS çalışmalarında, yıllık atak oranında %31-36 oranında azalma gözlenmiştir (36,37).…”

The future of multiple sclerosis treatments

“…In 4-to 6% of cases natalizumab treatment may induce the formation of persistent neutralising antibodies (NABs), usually within the first 12 months. The NABs are associated with higher rates of infusion-related adverse events and can lower the efficacy of the treatment [21].…”

“…Prophylaxis of herpetic infections with oral acyclovir is required during and for 28 days after alemtuzumab infusion [28]. In Europe alemtuzumab is licensed as a first-line medication in active RRMS, however some neurologists would use it as a second-line drug because of the risk of secondary autoimmunity [21].…”

“…Mitoxantrone is given in infusions at doses of 12 mg/m2 monthly however the cumulative dose is limited due to cardiologic and hematologic adverse effects. The use of mitoxantrone has rapidly decreased due to the risk of severe complications such as acute leukemia [40] and the increasing number of alternative highly effective and less toxic treatment options [21].…”