Principles of a new treatment algorithm in multiple sclerosis

Abstract

We are entering a new era in the management of patients with multiple sclerosis (MS). The first oral treatment (fingolimod) has now gained US FDA approval, addressing an unmet need for patients with MS who wish to avoid parenteral administration. A second agent (cladribine) is currently being considered for approval. With the arrival of these oral agents, a key question is where they may fit into the existing MS treatment algorithm. This article aims to help answer this question by analyzing the trial data for the new oral therapies, as well as for existing MS treatments, by applying practical clinical experience, and through consideration of our increased understanding of how to define treatment success in MS. This article also provides a speculative look at what the treatment algorithm may look like in 5 years, with the availability of new data, greater experience and, potentially, other novel agents.

Keywords::

• cladribine
• fingolimod
• glatiramer acetate
• interferon β
• mitoxantrone
• multiple sclerosis
• natalizumab
• oral treatment
• treatment algorithm

Financial & competing interests disclosure

Hans-Peter Hartung has received speaking fees and honoraria for consulting from Bayer Healthcare, Biogen Idec, Genzyme, EMD Merck Serono, Novartis, Teva Pharmaceuticals and Sanofi-Aventis, with approval of the rector of Heinrich-Heine University. Xavier Montalban has received speaking honoraria and travel expenses for scientific meetings and has been a steering committee member of clinical trials or participated in advisory boards of clinical trials with Bayer Schering Pharma, Biogen Idec, EMD Merck Serono, Genentech, Genzyme, Novartis, Sanofi-Aventis, Teva Pharmaceuticals and Almirall. Soelberg Sorensen has received honoraria for lecturing and advisory councils and trial steering committees and travel expenses for attending meetings from Biogen Idec, Bayer Schering, EMD Merck Serono, Teva Pharmaceuticals, Sanofi-Aventis, Novartis and Genmab. Patrick Vermersch has received honoraria and travel expenses for scientific meetings and advisory councils and/or financial support for research from Biogen Idec, Bayer Schering, EMD Merck Serono, Teva Pharmaceuticals, Sanofi-Aventis and Novartis. Tomas Olsson has received speaking honoraria and travel expenses for scientific meetings and advisory councils and/or financial support for research from Biogen Idec, EMD Merck Serono, Sanofi-Aventis, Novartis and Bayer Schering. The authors have no other 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 apart from those disclosed.

Editorial support for the writing of this manuscript was provided by Infusion Communications and was funded by Biogen Idec Inc. The authors were not compensated and retained full editorial control.