Emerging oral treatments in multiple sclerosis &amp;ndash; clinical utility of cladribine tablets

Gasperini, Claudio; Ruggieri, Serena; Pozzilli, Carlo

doi:10.2147/tcrm.s6639

Cited by 4 publications

(3 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 12 It is a therapy with a short-course dosing. It has a well-known safety profile derived from more than 15 years of use of the parenteral formulation in both the oncology field and MS. 13 …”

Section: Emerging Oral Agents For Multiple Sclerosismentioning

confidence: 99%

Patient considerations in the management of multiple sclerosis: development and clinical utility of oral agents

Girouard

Soucy²

2011

PPA

View full text Add to dashboard Cite

Multiple sclerosis (MS) is one of the most frequently occurring disabling neurological disorders among young adults in Canada. It is a chronic inflammatory disorder of the central nervous system (CNS) that is thought to be immune mediated in nature. An estimated 55,000–75,000 Canadians suffer from this debilitating disease. Starting in the mid-1990s, we witnessed the beginning of a new era in the treatment of MS. Treatments finally became available to help modify the course of the disease. Early initiation of treatment soon after diagnosis has become the expectation in many MS clinics, warranting many decisions to be made by the patient with the assistance of their health care team. Currently, there are two categories of disease-modifying therapies (DMTs) available: immunomodulatory and immunosuppressant agents. Although disease-modifying therapies are not a cure and are only moderately effective, they offer a possible slowing of any progression that may occur over time, a decrease in relapse activity, and a decrease in the amount of new lesions developing in the CNS found on magnetic resonance imaging. Not only have these agents been partly effective but up to now they have only been available parenterally, which has many limitations, including a major factor in determining the best outcome for the treatment: adherence. Four new DMTs will likely become available to Canadians over the next five years. Fingolimod, cladribine, teriflunomide, and laquinimod are likely to be marketed as the first oral DMTs in Canada. The US Food and Drug Administration approved fingolimod in September 2010 as a first-line therapy for relapsing forms of MS. Dalfampridine is also available in the US as an agent able to improve walking. Even if these agents present with higher efficacy and a promising safety and tolerability profile, thus possibly demonstrating better adherence, it will be imperative for the health care professionals to focus on monitoring and supporting the patient to ensure reliable reporting of side effects and to improve overall adherence. In the near future, more treatments will become available to the MS population, and choices will become even more complex so that ongoing support, open communication, and education are required to tame any uncertainties about decisions made regarding treatments.

show abstract

Section: Emerging Oral Agents For Multiple Sclerosismentioning

confidence: 99%

Patient considerations in the management of multiple sclerosis: development and clinical utility of oral agents

Girouard

Soucy²

2011

PPA

View full text Add to dashboard Cite

show abstract

“…A debilitating component of the disease is its relapsing-remitting nature, making it impossible to predict when, or for how long, a relapse will occur. Unfortunately, disease chronicity often results in an increase in symptom severity, with patients experiencing longer relapses and fewer remission periods, eventually transitioning into a secondary-progressive phase (Confavreux et al, 2000;Hartman & Rosenzweig, 2010;Pozzilli et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…Although disease modifying therapeutic strategies like interferon beta, natalizumab, fingolimod, teriflunomide and dimethyl fumarate help reduce relapse severity and slow disease progression, MS patients often progress to severe disability and rely on walking aids and assistance (Carvalho & Sá, 2012;Gajofatto & Benedetti, 2015;Hartman & Rosenzweig, 2010;Pozzilli et al, 2010). Unfortunately, what causes MS, why the immune system attacks myelin or how demyelination occurs, remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Glial Cell Plasticity During Development and Myelinopathies

Morris¹

View full text Add to dashboard Cite

Forming a functional vertebrate nervous system requires intricate interactions amongst various cell populations, including neurons and glia. Diverse populations of glial cells, such as myelinating glia, i.e., oligodendrocytes of the central nervous system (CNS) and Schwann cells and motor exit point (MEP) glia of the peripheral nervous system (PNS), and perineurial glia, which form the blood-nerve barrier, comprise the nervous system. ii

show abstract

Multiple Sclerosis

Pitts

Dyckman

2021

Burger's Medicinal Chemistry and Drug Discovery

View full text Add to dashboard Cite

Several new medicines have been approved or entered development for the treatment of Multiple Sclerosis (MS) in the past few years. The sphingosine‐1‐phosphate (S1P) modulator fingolimod was the first FDA approved oral disease modifying therapy for MS, and it has inspired a number of additional agents directed at this clinically validated target. Fumarates (e.g. dimethyl fumarate), dihydroorotate dehydrogenase inhibitors (e.g. teriflunomide) and other agents which decrease lymphocyte proliferation (e.g. cladribine) represent additional clinically validated therapeutic approaches. While the mechanisms of action for these new agents may not be fully defined, they have demonstrated a good degree of efficacy in the treatment of relapsing forms of MS. It is of interest to note that biologic agents which target CD20 on B cells have also shown significant efficacy in the treatment of MS. This, in turn, has spurred MS clinical trials with Bruton's Tyrosine Kinase (BTK) inhibitors, which also act on B cell pathways. The introduction of each of these newer agents still requires careful consideration of the risk–benefit for individual patients, but has also set a higher bar in the treatment of MS for subsequent agents, as evidenced by the discontinuation of several agents in late stage clinical trials. This higher bar has also pushed some historic agents to second or third line agents. This speaks to an overall advancement in the treatment of MS, and provides hope for further advances in therapeutic options.

show abstract

Emerging oral treatments in multiple sclerosis – clinical utility of cladribine tablets

Cited by 4 publications

References 35 publications

Patient considerations in the management of multiple sclerosis: development and clinical utility of oral agents

Patient considerations in the management of multiple sclerosis: development and clinical utility of oral agents

Glial Cell Plasticity During Development and Myelinopathies

Multiple Sclerosis

Contact Info

Product

Resources

About