New Medications for Multiple Sclerosis

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The MD Magazine Peer Exchange "Modifying the Course of Multiple Sclerosis in New Ways: The Latest Advances in Treatment" features a distinguished panel of physician experts discussing key topics in multiple sclerosis (MS) research and management, including the latest insights into MS pathophysiology, new medication options and their application in clinical practice, and more.

This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Pottstown Memorial Medical Center in Pottstown, PA, and medical director of Health Services at Ursinus College, in Collegeville, PA.

The panelists are:

• Fred D. Lublin, MD, FAAN, FANA, the Saunders Family Professor of Neurology and director of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, and co-chief editor of Multiple Sclerosis and Related Disorders at the Icahn School of Medicine at Mount Sinai
• Patricia K. Coyle, MD, professor of neurology, vice chair of Clinical Affairs, and director of MS Comprehensive Care Center
• Suhayl Dhib-Jalbut, MD, professor and chief of the Department of Neurology at Rutgers, Robert Wood Johnson Medical School

Doghramji started off this segment by asking the panelists, “In the last four or five years what have been the main breakthroughs as far as medications go? I know initially the biggest ones were disease-modifying injectables, but are there more injectables, oral, and/or IV options coming out?”

According to Coyle, “in the last five years we’ve had five new disease-modifying therapies approved for relapsing forms of MS. The most recent is pegylated interferon beta-1a, a new form of interferon beta. We have a monoclonal antibody (alemtuzumab) that has an initial 5-day cycle of treatment, one year later a 3-day cycle of treatment, and then you don’t treat again unless there’s breakthrough activity. And there are three oral agents, either pills or capsules. We have dimethyl fumarate, a twice-a-day capsule that was approved in 2013; we have teriflunomide which comes in two different doses, 7 or 14 milligrams, a daily pill; and we have fingolimod, a daily capsule, at a dose of 0.5 milligrams. Obviously these oral agents offer a non-injectable form of treatment so they were a major breakthrough.”

Lublin noted that comparative efficacy data has shown that the new oral agents are at least as effective and in some cases more effective than the therapies that preceded them.