Oral drugs in multiple sclerosis therapy: an overview and a critical appraisal

Abstract

Multiple sclerosis (MS) is characterized by demyelination and axonal loss that results in progressive disability. Recent advances in understanding the immune pathogenesis of MS resulted in the introduction of numerous effective drugs with diverse mechanisms of actions, routes of administration and benefit-risk profiles. New oral drugs recently approved for MS treatment has led to significant achievements in MS management. The oral route of administration promotes patient satisfaction and increases therapeutic compliance; but their introduction has raised concerns regarding safety and tolerability; and a thorough analysis of the benefit/risk ratio is required. This article reviews the mechanisms of action, safety and efficacy of the licensed and experimental oral drugs in MS. Moreover, we put into perspective the disease, drug and patient-related factors that should be taken into account when considering the appropriate oral drug and treatment strategy to the appropriate patient, thus paving the road for personalized medicine in MS.

Gonadal Steroids and Sperm Quality in a Cohort of Relapsing Remitting Multiple Sclerosis: A Case-Control Study

“…In this regard, no attention has been paid on men's fertility status in either research or clinical practice. In the pursuit of a personalized treatment, future studies are needed to clarify the impact of new DMTs on spermatogenesis and male fertility (23,24).…”

Comparable efficacy and safety of dimethyl fumarate and teriflunomide treatment in Relapsing-Remitting Multiple Sclerosis: an Italian real-word multicenter experience

“… 1 In the past 5 years, therapeutic options for treating relapsing remitting MS (RRMS) have impressively broadened and new oral first-line agents have been approved. 2 , 3 In European countries, delayed-release dimethyl fumarate (DMF), also known as gastro-resistant DMF, and teriflunomide (TRF) are used in the treatment of persons with RRMS (pwRRMS). 3 Pivotal trials have demonstrated the benefits of DMF and TRF on both clinical symptoms (i.e.…”

New treatment targets in multiple sclerosis therapy

“…In vitro the investigators reported that siponimod reduced the release of IL-6 from activated microglial cells in addition to astrogliosis and microgliosis reduction. The potential neuroprotective effect of siponimod suggested by these studies could explain the benefit observed on disability progression in patients with secondary progressive MS treated with this drug [10,18].…”

“…These are cell populations that have been shown to co-express latent EBV proteins and support a role for EBV infection in B-cell activation in MS brain [9]. This will need to be elucidated further [10].…”