Treatment options for patients with multiple sclerosis who have a suboptimal response to interferon-β therapy.
OBJECTIVE
Although the first-line disease-modifying therapies (DMTs) interferon beta and glatiramer acetate have a favourable benefit-to-risk profile, they are only partially effective for treating relapsing-remitting multiple sclerosis (RRMS). The optimization of treatment in patients who do not show a maximum response to first-line therapy is critical for achieving the best long-term outcomes. Treatment strategies for patients with a suboptimal response include switching to another first-line DMT or a second-line DMT. Natalizumab and fingolimod are approved for RRMS with high disease activity in the European Union and Canada.


METHODS
A comprehensive literature search for articles published between 1990 and April 2012 was undertaken.


RESULTS
This review discusses key clinical and safety data for fingolimod and natalizumab, particularly in the patient subgroups for whom these treatments are approved. Benefit-to-risk profiles, including first-dose cardiovascular effects associated with fingolimod and the risk of progressive multifocal encephalopathy with natalizumab, are discussed.


CONCLUSIONS
A descriptive comparison of fingolimod and natalizumab is provided in the context of the decision-making process of how and when to switch patients who have a suboptimal response to first-line therapy.
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
M S
MS
Freedman
D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D003657:Decision Making; D000068876:Fingolimod Hydrochloride; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016899:Interferon-beta / Q000627:therapeutic use*; D009103:Multiple Sclerosis / Q000188:drug therapy*; D000069442:Natalizumab; D011409:Propylene Glycols / Q000627:therapeutic use*; D013110:Sphingosine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D000069442:Natalizumab; D011409:Propylene Glycols; D016899:Interferon-beta; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine
disease-modifying drugs; fingolimod; natalizumab; relapsing-remitting multiple sclerosis; treatment failure; treatment strategy