New management algorithms in multiple sclerosis.
OBJECTIVE
Our current treatment algorithms include only IFN-β and glatiramer as available first-line disease-modifying drugs and natalizumab and fingolimod as second-line therapies. Today, 10 drugs have been approved in Europe and nine in the United States making the choice of therapy more complex. The purpose of the review has been to work out new management algorithms for treatment of relapsing-remitting multiple sclerosis including new oral therapies and therapeutic monoclonal antibodies.


RESULTS
Recent large placebo-controlled trials in relapsing-remitting multiple sclerosis have shown efficacy of new oral disease-modifying drugs, teriflunomide and dimethyl fumarate, with similar or better efficacy than the injectable disease-modifying drugs, IFN-β and glatiramer acetate. In addition, the new oral drugs seem to have a favorable safety profile. Further, the monoclonal antibody alemtuzumab, which in clinical trials has shown superiority to subcutaneous IFN-β 1a, has been approved in Europe, but not yet in the United States.


CONCLUSIONS
In de novo-treated patients, the injectables, IFN-β and glatiramer acetate, will to a great extent be replaced by the new orals, dimethyl fumarate and teriflunomide. However, patients who are stable on an injectable with no or minor side-effects could continue their current therapy. Alemtuzumab should be used as a second-line therapy.
Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
Per Soelberg
PS
Sorensen
D000074323:Alemtuzumab; D000465:Algorithms; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D002985:Clinical Protocols; D003437:Crotonates / Q000627:therapeutic use; D000069462:Dimethyl Fumarate; D000068876:Fingolimod Hydrochloride; D005650:Fumarates / Q000627:therapeutic use; D000068717:Glatiramer Acetate; D006801:Humans; D006885:Hydroxybutyrates; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016899:Interferon-beta / Q000627:therapeutic use; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D000069442:Natalizumab; D009570:Nitriles; D010455:Peptides / Q000627:therapeutic use; D011409:Propylene Glycols / Q000627:therapeutic use; D013110:Sphingosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014052:Toluidines / Q000627:therapeutic use
D061067:Antibodies, Monoclonal, Humanized; D003437:Crotonates; D005650:Fumarates; D006885:Hydroxybutyrates; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069442:Natalizumab; D009570:Nitriles; D010455:Peptides; D011409:Propylene Glycols; D014052:Toluidines; C527525:teriflunomide; D000074323:Alemtuzumab; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D000069462:Dimethyl Fumarate; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine