Recent advances in the treatment of multiple sclerosis

Figures & data

Figure 1 Proposed mechanism of action of selected emerging therapies in MS.

Table 1 Summary of characteristics, efficacy, and safety information on selected MS therapies

	Mechanism of action	Route/dose	Results	AEDs
Alemtuzumab	Anti-CD52	IV 12 mg dose/y	75% ↓ SAD (12 mg dose), 74% ↓ RR	ITP (3 pts), Graves (20%)
Daclizumab	Anti-CD25/anti-IL2, NK CD56	SQ 2 mg/kg (Q2w)	72% ↓ CEL in RRMS patients	Skin rash, chest discomfort, headaches, lymphopenia
Rituximab	Anti-CD20	IV (1 g dose,Q2w, ×2)	91% ↓ CEL in RRMS	Infusion reaction, allergies
Fingolimod	Sphingosine-1-phosphate (S1P) analog	Oral (0.5 and 1.25 mg)	54%–60% ↓ ARR	Bradycardia, nasopharyngitis, dyspnea, headaches, diarrhea and nausea, hemorrhagic encephalitis, skin cancer
Laquinimod	Anti-inflammatory	Oral 0.6 mg/d	40% ↓ CEL	LFT elevation, Budd–Chiari
Fumaric acid (BG12)	Anti-inflammatory/neuroprotective	Oral (120–240 mg TID)	69% ↓ CEL	Diarrhea, cramps, nausea and flushing
Teriflunomide	Inhibition of immune cell proliferation	Oral (7 and 14 mg dose)	61% ↓ CEL	Nasopharyngitis, alopecia, nausea, limb pain, diarrhea, and arthralgia
Cladribine	Purine nucleoside analog	Oral (3.5 and 5.25 mg/kg total dose)	58% ↓ RR, 43% disease free	HZV, lymphopenia, HA, nasopharyngitis, lymphopenia

Abbreviations: ARR, annualized relapse rate; CEL, contrast enhancing MRI lesions; HA, headaches; HZV, herpes zoster virus; ITP, immune thrombocytopenic purpura; IV, intravenous; LFT, liver function test; RR, relapse rate; RRMS, relapsing remitting multiple sclerosis; SAD, sustained acumulation of disability; SQ, subcutaneous.