Oral treatment for multiple sclerosis. 2011

Joep Killestein, and Richard A Rudick, and Chris H Polman
Department of Neurology, Multiple Sclerosis Centre Amsterdam, Vrije University Medical Centre, Amsterdam, Netherlands. j.killestein@vumc.nl

BACKGROUND The armamentarium for the treatment of relapsing-remitting multiple sclerosis (RRMS) is increasing rapidly. Several oral treatments have shown benefit and will generate much interest because of the convenience of such administration. However, availability of convenient oral drugs will not necessarily translate into clinical effectiveness and safety. Here, we provide an interim report about the mechanisms of action, and efficacy and safety results that have been reported since January, 2010, for five new oral drugs. Additionally, we draw attention to issues that neurologists and patients will encounter when considering the use of new oral drugs. BACKGROUND Positive results have been reported for five new oral drugs for RRMS--fingolimod, cladribine, teriflunomide, laquinimod, and dimethyl fumarate--in phase 3 studies; a few new oral drugs are likely to be approved for RRMS soon. WHERE NEXT?: Emerging oral treatments are ushering in a new era in the treatment of MS, providing not only new treatment options but also new challenges. Since data for some of the new drugs have not been reported in peer-reviewed journals yet and safety profiles are not yet fully developed, opinions about the use of these new oral drugs in practice are preliminary and tentative. Practice will evolve with time as information and experience accumulates. Of importance will be results from comparator trials, information about management of patients with breakthrough disease, results from long-term safety studies, and results of studies to assess the potential for neuroprotective effects of the new drugs.

UI MeSH Term Description Entries
D007166 Immunosuppressive Agents Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of T-CELLS or by inhibiting the activation of HELPER CELLS. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of INTERLEUKINS and other CYTOKINES are emerging. Immunosuppressant,Immunosuppressive Agent,Immunosuppressants,Agent, Immunosuppressive,Agents, Immunosuppressive
D009570 Nitriles Organic compounds containing the -CN radical. The concept is distinguished from CYANIDES, which denotes inorganic salts of HYDROGEN CYANIDE. Nitrile
D011409 Propylene Glycols Derivatives of propylene glycol (1,2-propanediol). They are used as humectants and solvents in pharmaceutical preparations. Propanediols,Glycols, Propylene
D002986 Clinical Trials as Topic Works about pre-planned studies of the safety, efficacy, or optimum dosage schedule (if appropriate) of one or more diagnostic, therapeutic, or prophylactic drugs, devices, or techniques selected according to predetermined criteria of eligibility and observed for predefined evidence of favorable and unfavorable effects. This concept includes clinical trials conducted both in the U.S. and in other countries. Clinical Trial as Topic
D003437 Crotonates Derivatives of BUTYRIC ACID that include a double bond between carbon 2 and 3 of the aliphatic structure. Included under this heading are a broad variety of acid forms, salts, esters, and amides that include the aminobutryrate structure. 2-Butenoic Acids,Crotonic Acids,2 Butenoic Acids,Acids, 2-Butenoic,Acids, Crotonic
D005650 Fumarates Compounds based on fumaric acid. Fumarate,Fumaric Acid Ester,Fumaric Acid Esters,Fumarate Esters,Acid Ester, Fumaric,Acid Esters, Fumaric,Ester, Fumaric Acid,Esters, Fumarate,Esters, Fumaric Acid
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006885 Hydroxybutyrates Salts and esters of hydroxybutyric acid. Hydroxybutyric Acid Derivatives,Hydroxybutyric Acids,Acid Derivatives, Hydroxybutyric
D000068876 Fingolimod Hydrochloride A sphingosine-derivative and IMMUNOSUPPRESSIVE AGENT that blocks the migration and homing of LYMPHOCYTES to the CENTRAL NERVOUS SYSTEM through its action on SPHINGOSINE 1-PHOSPHATE RECEPTORS. It is used in the treatment of MULTIPLE SCLEROSIS. 2-Amino-2-(2-(4-octylphenyl)ethyl)-1,3-propanediol hydrochloride,FTY 720,FTY-720,FTY720,Fingolimod,Gilenia,Gilenya
D000069462 Dimethyl Fumarate A fumarate derivative that is used as a DERMATOLOGIC AGENT in the treatment of PSORIASIS and SKIN DISEASES. It also may be used as an IMMUNOSUPPRESSIVE AGENT in the treatment of MULTIPLE SCLEROSIS. 2-butenedioic acid, (2E)-, dimethyl ester,BG 00012,BG 12 compound,BG-00012,BG-12 compound,BG00012,BG12 compound,Dimethylfumarate,FAG 201,FAG-201,FAG201,Fumaderm,Tecfidera,00012, BG,12 compound, BG,201, FAG,Fumarate, Dimethyl,compound, BG 12,compound, BG12

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