New management algorithms in multiple sclerosis
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New management algorithms in multiple sclerosis. / Sorensen, Per Soelberg.
In: Current Opinion in Neurology, Vol. 27, No. 3, 06.2014, p. 246-259.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - New management algorithms in multiple sclerosis
AU - Sorensen, Per Soelberg
PY - 2014/6
Y1 - 2014/6
N2 - PURPOSE OF REVIEW: Our current treatment algorithms include only IFN-β and glatiramer as available first-line disease-modifying drugs and natalizumab and fingolimod as second-line therapies. Today, 10 drugs have been approved in Europe and nine in the United States making the choice of therapy more complex. The purpose of the review has been to work out new management algorithms for treatment of relapsing-remitting multiple sclerosis including new oral therapies and therapeutic monoclonal antibodies.RECENT FINDINGS: Recent large placebo-controlled trials in relapsing-remitting multiple sclerosis have shown efficacy of new oral disease-modifying drugs, teriflunomide and dimethyl fumarate, with similar or better efficacy than the injectable disease-modifying drugs, IFN-β and glatiramer acetate. In addition, the new oral drugs seem to have a favorable safety profile. Further, the monoclonal antibody alemtuzumab, which in clinical trials has shown superiority to subcutaneous IFN-β 1a, has been approved in Europe, but not yet in the United States.SUMMARY: In de novo-treated patients, the injectables, IFN-β and glatiramer acetate, will to a great extent be replaced by the new orals, dimethyl fumarate and teriflunomide. However, patients who are stable on an injectable with no or minor side-effects could continue their current therapy. Alemtuzumab should be used as a second-line therapy.
AB - PURPOSE OF REVIEW: Our current treatment algorithms include only IFN-β and glatiramer as available first-line disease-modifying drugs and natalizumab and fingolimod as second-line therapies. Today, 10 drugs have been approved in Europe and nine in the United States making the choice of therapy more complex. The purpose of the review has been to work out new management algorithms for treatment of relapsing-remitting multiple sclerosis including new oral therapies and therapeutic monoclonal antibodies.RECENT FINDINGS: Recent large placebo-controlled trials in relapsing-remitting multiple sclerosis have shown efficacy of new oral disease-modifying drugs, teriflunomide and dimethyl fumarate, with similar or better efficacy than the injectable disease-modifying drugs, IFN-β and glatiramer acetate. In addition, the new oral drugs seem to have a favorable safety profile. Further, the monoclonal antibody alemtuzumab, which in clinical trials has shown superiority to subcutaneous IFN-β 1a, has been approved in Europe, but not yet in the United States.SUMMARY: In de novo-treated patients, the injectables, IFN-β and glatiramer acetate, will to a great extent be replaced by the new orals, dimethyl fumarate and teriflunomide. However, patients who are stable on an injectable with no or minor side-effects could continue their current therapy. Alemtuzumab should be used as a second-line therapy.
KW - Algorithms
KW - Antibodies, Monoclonal, Humanized
KW - Clinical Protocols
KW - Crotonates
KW - Fumarates
KW - Humans
KW - Immunologic Factors
KW - Immunosuppressive Agents
KW - Interferon-beta
KW - Multiple Sclerosis, Relapsing-Remitting
KW - Peptides
KW - Propylene Glycols
KW - Sphingosine
KW - Toluidines
U2 - 10.1097/WCO.0000000000000096
DO - 10.1097/WCO.0000000000000096
M3 - Review
C2 - 24759080
VL - 27
SP - 246
EP - 259
JO - Current Opinion in Neurology
JF - Current Opinion in Neurology
SN - 1350-7540
IS - 3
ER -
ID: 138428679