title: Update on monitoring and adverse effects of approved second-generation disease-modifying therapies in relapsing forms of multiple sclerosis.
abstract: There has been a considerable increase in the number of disease-modifying therapies (DMTs) in recent years. It appears that the number of approved DMTs is going to continue to increase in the coming years. The growing number of DMTs has provided a challenge to the clinician to tailor their therapeutic recommendations based on patients' needs and preferences. To choose between these DMTs, knowledge of side-effect profiles is imperative.
  
  
  
  Alemtuzumab, a humanized recombinant monoclonal antibody, was recently approved for the management of relapsing forms of multiple sclerosis. Its use seems to be limited by significant adverse effects and regular monitoring requirement. In 2014, the first case of progressive multifocal leukoencephalopathy (PML) was diagnosed in a patient with relapsing remitting multiple sclerosis who received extended dimethyl fumarate without any significant confounding factors. Among patients receiving fingolimod after previous natalizumab treatment, there have been 17 suspected cases of PML. There have also been three confirmed cases of PML in individuals who received fingolimod without previous natalizumab treatment.
  
  
  
  In this review, we outline the potential adverse effects and recommended laboratory studies as part of the monitoring strategy following initiation of various DMTs.
authors.affiliation: Department of Neurology and Neurotherapeutics, Neurology Section, University of Texas Southwestern Medical Center, VA North Texas Health Care System, Medical Service, Dallas, Texas, USA.
authors.forename: Divyanshu
authors.initials: D
authors.lastname: Dubey
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Cano
authors.forename: Olaf
authors.initials: O
authors.lastname: Stüve
mesh_terms: D000074323:Alemtuzumab / Q000009:adverse effects* / Q000627:therapeutic use; D000068876:Fingolimod Hydrochloride / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D000069442:Natalizumab / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D007155:Immunologic Factors; D000069442:Natalizumab; D000074323:Alemtuzumab; D000068876:Fingolimod Hydrochloride