With several medications in or near FDA review, the battle against relapsing-remitting multiple sclerosis is shaping up to be quite promising. There have been several therapies with comparison trials to “first line agents,” with the newer drugs generally looking superior. Novel drugs appear to offer enhanced efficacy, oral or IV delivery, and convenient dosing (IV alemtuzumab being given very infrequently).
All the late-stage agents show promise, and it’s difficult to pick just one as a “winner,” says John Corboy, MD, Professor of Neurology at the University of Colorado and an MS specialist. “Certainly BG-12 has a favorable side effect and efficacy profile. I believe all that get approved will have a role in our armamentarium.” Dr. Corboy believes several things will potentially change in the next three to five years:
- Definition earlier on of those patients with more challenging prognosis, and movement to more efficacious/ potentially dangerous drugs more rapidly, even as “first line therapy;”
- Greater use of oral medications;
- Greater use of Biomarkers (we already use interferon and natalizumab antibodies, and JC virus serology) to define and predict response to medications, risk of medications, i.e. more personalized medicine;
- Identification of individuals who either don’t need to start medication (i.e. “benign MS” identified early on, perhaps with a biomarker), or who should consider discontinuation of medications (beyond the obvious stopping due to lack of efficacy or side effects), i.e. individuals who have prolonged periods of lack of disease activity, and who have reached a certain age where new disease activity is much less likely; and those for whom therapies are, unfortunately, not likely to be helpful anymore. This would include, for examples, those who have transitioned to a secondary progressive phase, with no evidence or likelihood of recurrent disease activity that would respond to available medications. Of course, we maintain the hope that newer therapies would have a positive impact.
On these pages, we’ve compiled key information on the ongoing and recently completed Phase III and IV RR-MS trials and the drugs that may make frequent appearances on your prescription pad for the treatment of MS in the next several years.