Emerging multiple sclerosis oral therapies.
Currently, patients suffering from multiple sclerosis (MS), a chronic demyelinating disorder of the CNS, must be injected with medication to provide modest relief for their symptoms. Five orally available therapies are being evaluated in phase II/III clinical trials. If these therapies prove safe and tolerable, oral compounds may improve patient endorsement and compliance. Fingolimod, a novel immunosuppressant, significantly lowered annual relapse rates in phase II/III trials. Laquinimod, an immunomodulator, reduced the cumulative number of active lesions at the highest dose tested (0.6 mg/d) in a phase II trial. Cladribine, another immunomodulator, reduced annual relapse rates by >50% and gadolinium-positive lesions by >70% at both doses tested in a phase III trial. Oral fumarate, with immunomodulatory and antioxidant properties, also lowered the number of lesions in a phase II trial. Finally, teriflunomide, an immunomodulator, significantly reduced MRI lesion activity and reduced annual relapse rates in a phase II trial. In this report, we weigh the beneficial outcomes of these compounds against their risks of adverse effects.
Rammohan
Kottil W
KW
The MS Center, Columbus, OH 43221, USA. Kottil.Rammohan@osumc.edu
Shoemaker
Jennifer
J
D000284:Administration, Oral; D002986:Clinical Trials as Topic / Q000639:trends*; D005544:Forecasting; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007167:Immunotherapy / Q000639:trends*; D009103:Multiple Sclerosis / Q000188:drug therapy*; D016896:Treatment Outcome
D007155:Immunologic Factors; D007166:Immunosuppressive Agents