Questions Remain on Best Course for Multiple Sclerosis Treatment

Whether patients need to move to stronger medications, or find a more effective treatment, doctors need as much information as possible before making a decision on what course to follow.

For some patients, Tomas Kalincik, MD, PhD, said their initial treatment like fingolimod may not be enough to manage their symptoms. For others, they may have side effects associated with their medication which could require a change in treatment as well:

What can this mean for providers?

I think that it may influence the way people use medication, particularly in situations where, as I indicated earlier where natalizumab is discontinued for the reason of potential side effects.

But also, it may influence the way clinicians devise their patients to escalate therapy, for example, escalation from fingolimod to more potent therapy. This way they can suggest both natalizumab and alemtuzumab as fairly equivalent strategies whereas before we didn’t have that information.

Were there limitations to the study?

The limitations are the lack of MRI information in our comparison, which is something that we are not able to adjust for. And the earlier mentioned lack of safety data.

Therefore, these will be two topics that we two topics that we want to look closer into and complete this data and reanalyze the information with this information on board.

How do you resolve unanswered questions?

We have done a sensitivity analysis for this study, which included not only relapsing remitting patients, but also people with secondary progressive disease. We were able to replicate the results of the primary analysis with, there was a combined cohort of RM, NS, PMS.

Of course the outstanding question is, how would these medications perform in SPMS, unfortunately our SPMS cohort treated with either of two medications was too small to enable such an analysis but it would be very interesting once we have enough data from SPMS to compare the outcomes of the therapies in that setting.