The Current State of Immune Therapy in Multiple Sclerosis in Japan and Future Prospects

Abstract

Among neuroimmunological disorders, the most common disease is multiple sclerosis (MS). MS is an intractable disease particularly affecting young adults and is increasing all over the world, including Japan. The main goal of treatment is to decrease the frequency of relapses, manage symptoms, improve function, and delay disease progression for good quality of life. To prevent relapses, interferon beta 1b, an injectable disease-modifying therapy (DMT), has been used; however, it has been only available in Japan since 2000, about seven years behind world usage, because of the drug lag caused by healthcare system barriers. At present, second-line DMTs, such as fingolimod and natalizumab, are available; both are more effective compared to first-line injectable interferons and glatiramer acetate (approved on September 28, 2015). However, it is still difficult to block the neurodegenerative process of axonal damage, and that is why there is no cure for MS. In this article, we summarize current immunotherapy in Japan and discuss the pros and cons of the newer DMTs, which might modulate disease course.We also discuss the future prospects of DMTs. Even if DMT treatment is initiated immediately after the completion of diagnosis, patients need to remain on therapy for a long period of time. Adhering patients to treatment is another important aspect. In this regard, a treatment algorithm for escalation therapy or early aggressive induction therapy is not a final decision, and we need to reconsider other better options with low risk of drug adverse effect, and exclude pregnancy-related risks in females.