Almost all the coming new
drugs carry new risks.
to the new drugs, we can expect an influx of new
names tagged “bioequivalent,” “biosimilar” or
“biogeneric”—all variants considered equivalent to
the older standard MS drugs.
progressive MS. Hopes raised for
meeting this urgent need have been
dashed by discouraging results. A
recent large clinical trial of ritux-
imab in primary progressive MS
had poor results although reviews
are in progress to see if some
subgroups experienced benefits. A
clinical trial of Gilenya for progres-
sive MS is just beginning.
Will competition lower costs, as market models
say? How will insurance companies respond to
claims?;No;one;really;knows.;But;Dr.;Ransohoff
suggests it will take some time before good study
data support clear choices. Will the lack of evidence for superior or comparative effectiveness
give any insurers a reason to deny claims?
Taking a different tack, a number of investigators
are pursuing therapies that can protect or repair
damaged nerve cells, rather than reduce inflammation since inflammation is less prominent in
progressive MS.
Not enough to say about progressive MS
We still seem to be far from effective treatments
for primary progressive or advanced secondary
Safe, but not always producing results
Over;the;past;two;decades,;the;gray;unknowns
initially surrounding the first generation of MS
disease modifiers have slowly receded. The standard therapies are supported by robust data and
years of clinical experience. Betaseron (and its
equivalent,;Extavia),;Avonex,;Copaxone;and;Rebif
are all remarkably safe. Their side effects are not
Teriflunomide
•;One;tablet;a;day;for;relapsing;forms;of;MS.
Under study for use in CIS (clinically isolated
syndrome, or one demyelinating attack with
MRI;suggesting;MS)
•;Might;be;both;a;stand-alone;therapy;or;used;in
combination with one of the standard disease-
modifying drugs
•;Effect;on;MS:;preliminary;data;show;31%
reduction in relapse rate versus placebo with
lowered rate of progression
•;Risks:;May;include;low;white;blood;cell
counts, nausea, mildly elevated liver enzymes,
thinning hair, and reproductive system effects
•;Possible;benefit:;Some;study;data;suggest;it
might have neuroprotective effects because it
inhibits an enzyme that produces nitric oxide,
a powerful free radical that contributes to
nerve cell breakdown in MS
•;Pregnancy:;May;be;teratogenic,;meaning;it
could affect both sperm and eggs. A year’s
waiting period for both men and women
may be recommended before trying to
conceive.
