Assessing the risk of multiple sclerosis disease-modifying therapies

ABSTRACT

Introduction: The number of immunomodulatory options approved for multiple sclerosis has increased over the past years, resulting in a better control of the disease. Depending on disease activity, neurologists can now propose treatments with different levels of efficacy, from injectable and oral treatments with modest efficacy, to highly active immunosuppressants. Nevertheless, this gain in efficacy has come with an increase in the global burden of treatment-related adverse events.

Areas covered: The authors have reviewed extensively the existing literature to gain insight into the adverse events associated with disease modifying therapies, so as to help neurologists choose the right treatment for their patients. The authors classified and summarized the adverse events based on frequency, severity and relevance.

Expert opinion: As the number and diversity of adverse events is expected to increase, careful surveillance of patients under treatment will be even more important. The characteristics of the MS population, i.e. mainly young women of childbearing age, who will remain treated for decades, and the need for serial administration of distinct treatments with different mechanisms of action highlights the importance of a comprehensive risk-benefit assessment.

KEYWORDS:

• Multiple sclerosis
• disease modifying therapies
• adverse events
• benefit-risk ratio
• monitoring

Article highlights

• There is an expanding diversity of DMTs to treat MS.

• The more recent DMTs have a higher efficacy than the original injectable DMTs.

• Higher efficacy often equates higher toxicity.

• The number and diversity of SAEs is increasing as more patients are exposed over a longer period of time.

• Clinicians, when choosing an MS-DMT, must weigh the risk-benefit ratio.

• A close surveillance for possible AEs is mandatory.

• Any unexpected clinical event could be related to a current, or previous DMT.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.