Oral treatment for multiple sclerosis.
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.
Department of Neurology, Multiple Sclerosis Centre Amsterdam, Vrije University Medical Centre, Amsterdam, Netherlands. j.killestein@vumc.nl
Joep
J
Killestein
Richard A
RA
Rudick
Chris H
CH
Polman
D000284:Administration, Oral; D017338:Cladribine / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003437:Crotonates / Q000008:administration & dosage / Q000627:therapeutic use*; D000069462:Dimethyl Fumarate; D000068876:Fingolimod Hydrochloride; D005650:Fumarates / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006885:Hydroxybutyrates; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D009570:Nitriles; D011409:Propylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use*; D015363:Quinolones / Q000008:administration & dosage / Q000627:therapeutic use*; D013110:Sphingosine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014052:Toluidines / Q000008:administration & dosage / Q000627:therapeutic use*
D003437:Crotonates; D005650:Fumarates; D006885:Hydroxybutyrates; D007166:Immunosuppressive Agents; D009570:Nitriles; D011409:Propylene Glycols; D015363:Quinolones; D014052:Toluidines; C527525:teriflunomide; D017338:Cladribine; C476223:laquinimod; D000069462:Dimethyl Fumarate; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine