[Oral treatments in multiple sclerosis].
The development of new disease-modifying drugs (DMD) in relapsing-remitting multiple sclerosis (RRMS), which share the common denominator of oral administration, considerably improves patient expectations in terms of effectiveness, tolerability and treatment adherence compared with currently available drugs. However, the common route of administration of these drugs does not mean that they are equivalent, since the heading of "oral route" encompasses drugs with distinct indications and mechanisms of action, as well as heterogeneous results in terms of efficacy and safety, allowing treatment to be personalized according to the each patient' s characteristics. Currently, four oral DMD are available or in an advanced stage of clinical development: fingolimod, teriflunomide, dimethyl fumarate and laquinimod. In pivotal trials versus placebo, these molecules reduced the annualized rate of exacerbations versus placebo by 54%, 31%, 53% and 23%, respectively, the risk of progression of disability by 31%, 30%, 38% and 36%, and the number of active lesions showing contrast uptake on magnetic resonance imaging by 82%, 80%, 90% and 37%, respectively. Based on the risk/benefit ratio, fingolimod is indicated in patients with suboptimal response to initial DMD or in severe rapidly progressing RRMS, while the remaining drugs can be used as first-line options. Clinical experience with these treatments will provide new data on safety and effectiveness, which will be determinant when establishing therapeutic algorithms.
Unidad de Esclerosis Múltiple, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM, Universidad Católica San Antonio de Murcia, Murcia, España. Electronic address: pmecal@gmail.com.
José Eustasio
JE
Meca-Lallana
Unidad de Esclerosis Múltiple, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM, Universidad Católica San Antonio de Murcia, Murcia, España.
Rocío
R
Hernández-Clares
Unidad de Esclerosis Múltiple, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM, Universidad Católica San Antonio de Murcia, Murcia, España.
Ester
E
Carreón-Guarnizo
D000284:Administration, Oral; D003437:Crotonates / Q000008:administration & dosage; D000069462:Dimethyl Fumarate; D000068876:Fingolimod Hydrochloride; D005650:Fumarates / Q000008:administration & dosage; D006801:Humans; D006885:Hydroxybutyrates; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D009103:Multiple Sclerosis / Q000188:drug therapy*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy; D009570:Nitriles; D011409:Propylene Glycols / Q000008:administration & dosage; D015363:Quinolones / Q000008:administration & dosage; D013110:Sphingosine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014052:Toluidines / Q000008:administration & dosage
D003437:Crotonates; D005650:Fumarates; D006885:Hydroxybutyrates; D007166:Immunosuppressive Agents; D009570:Nitriles; D011409:Propylene Glycols; D015363:Quinolones; D014052:Toluidines; C527525:teriflunomide; C476223:laquinimod; D000069462:Dimethyl Fumarate; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine
Dimethyl fumarate; Dimetilfumarato; Esclerosis múltiple; Fingolimod; Laquinimod; Multiple sclerosis; Oral therapy; Teriflunomida; Teriflunomide; Tratamiento oral