Multiple Sclerosis Drug Selection

[Marco]

Hi Teeky!
I'm sorry for the late response. I have been on vacation and just recently returned. I actually posted this article while working on a book about MS medications. Since I completed my book both plegridy and lemtrada have been approved and released. I really wouldn't change much from the original post. I still believe it's important to start therapy as early in the disease process as possible. Our medications just work better in the earlier inflammatory stages of the disease.

What else is generally true is that with greater risks come greater rewards. Our most statistically effective medications also have the most serious potential side effects. Of course, each person is different and the "safest" statistical medication can be the most dangerous to any individual. I would personally like to be on a medication with decent efficacy so if I was torn between two medications I would probably try the one with the higher average efficacy first.

Starting our medications can be stressful. Not only are you concerned about MS, but also the medication side effects, then the insurance issues, copayments and the 2-4 week wait before the medications arrive. Starting a medication on Friday versus Wednesday will have a negligible impact on the vast majority of patients. For me, considering my medication has a "friend" or "helper" allows me to better withstand the side effects.

I wish you well ...

[Teekybird]

I also printed this out to have as reference! Thank you!

Marco, I am wondering if there is anything that you would add to the original post, now that it is about a year and a half since the original.

Also, I am wondering what day/time you host chat? I would be very interested in talking with you.

I am newly diagnosed, 38 years old and JC virus negative. Currently looking to start my first MS medication (aka DMT, aka DMD. ). My presenting symptom was optic neuritis in right eye, diagnosed late Feb. Really really looking to hear others' opinions and experiences in general. I know that each situation is unique and each person should make their own informed decision based on their circumstances/goals.

[Marco]

Thank you Marco for the summary of DMDs
My diagnosis is SPMS and I believe no DMDs at all are approved for progressive ms. Am I correct?

What is your opinion of Mabthera ?

Tomas

Tomas,
Since there is no biomarker to differentiate between RRMS and SPMS a number of patients are misdiagnosed SPMS<> RRMS. Even with a SPMS diagnosis, most US-based neurologists will let you stay on whatever DMT you are on, provided they believe it is a benefit. The FDA has only approved Novantrone/mitoxantrone for SPMS.

I know MabThera as Rituximab and have seen the use of it increase over time. One problem with MabThera is the patent is running out and that may change how things a bit.
It's only a matter of time before Rituximab has not only generic version, but also a number of anti cd20 challengers.
The anti cd20 monoclonal antibody space is certainly getting interesting with a number of other entrants (i.e. Ibritumomab, Ocrelizumab, Ofatumumab, Obinutuzumab, Tositumomab, and Veltuzumab).

I'm going to withhold an opinion, but will say if it wasn't for the patent problems this drug might be stealing marketshare from Tysabri.

[Myoak]

Marco,

Really an outstanding post. I almost feel as though I'm contaminating the thread by adding anything so I hope the following material is appropriate.

It is meant as an overall view; most percentages were rounded off by Dr. Miller, a neurologist referenced later.

Quick Reference of 12 MS meds

Percentages are compared to placebo and are approximate!

1. Copaxone… injection under the skin every other day
Reduces relapses………………….. 30%
Reduces new MRI lesions……… 40%

2. Avonex… muscle injection once a week
Reduces relapse……………………. 30%
Reduces new MRI lesions.…….. 60%

3. Rebif… injection under the skin 3 times a week
Reduces relapses………………….. 30%
Reduces new MRI lesions……... 60%

4. Pelgridy… injection every two weeks
Reduces relapses………………….. 30%
Reduces new MRI lesions……… 60%

5. Betaseron… injection under the skin every other day
Reduces relapses…………………… 30%
Reduces new MRI lesions………. 60%

6. Extavia… same med as Betaseron

7. Tysabri… infusion every 4 to 8 weeks
Reduces relapses……………………. 70%
Reduces new MRI lesions……….. 90%

8. Gilenya… oral capsule once a day
Reduces relapses……………………. 50%
Reduces new MRI lesions……….. 75%

9. Aubagio… oral tablet once a day
Reduces relapses……………………. 30%
Reduces new MRI lesions……….. 50%

10. Tecfidera… oral capsule twice a day
Reduces relapses……………………. 50%
Reduces new MRI lesions……….. 70%

11. Novantrone (mitoxantrone) limited use, currently
In 2000, mitoxantrone was approved for the treatment of worsening RRMS in patients whose neurological function remains abnormal between relapses, at a 12 mg/m2 IV dose administered every 3 months. I believe it is also a drug indicated for the treatment of SPMS and is approved for patients with PRMS.

12. Lemtrada… approved in the EU not in USA, yet
5 infusions followed by 3 more a year later
Reduces relapses estimated at 80%
Reduces new MRI lesions est at 70%

Reductions in relapse rate and new MRI lesions vary mildly in each published study. The percentages used here are approximate and rely primarily on a presentation by a neurologist which can be viewed on YouTube by entering “DR MILLER ON DMT”.

http://www.youtube.com/watch?v=cOO7blVRsgo

Best.

[Marco]

Thank you! This was one of the post I had made while writing my book. I am so glad that people find it useful. I look at it and am reminded how my cognitive issues are a daily challenge that I often lose. I wish you well !

[Diamond57]

Marco

Thank you dear Marco. Printing it out. Great info. Always love reading your posts.

Diamond57

[502E79]

Excellent piece Marco! Thank you.

A hard copy should be posted in my neuro's waiting room.

It contains more info than he has given me in 7 years.

Jer

[Tomasni]

Thank You Marco

Thank you Marco for the summary of DMDs
My diagnosis is SPMS and I believe no DMDs at all are approved for progressive ms. Am I correct?

What is your opinion of Mabthera ?

Tomas

**Moderators note: Do not post personal information**

[suenan]

Thank you so much for this information. I've been on Avonex since diagnosed in October, but a new insurance started in January that does not pay for Avonex. They do pay for two others and I knew nothing about either. This helped a lot - so glad I found this! Thanks!

[Strhuntrss]

You are an asset to ...

Thank you so much Marco ... You are an asset to MSWorld.

Your discussion on meds and treatments was a world of information for me. I decided against DMD's for reasons of confusion.

You helped me with my confusion on how DMD's might and might not help me with my personal struggle that is unique to me.

I am sure that you will find that others will be just as thankful for your time and effort in explaining and helping others out with their personal journey and decisions.

God Bless you Marco, for you are truely an asset to MSWorld.

[Camsue]

Thank you

Thank you Marco! I printed it out for reference ..It's 5 pages...thanks for all the work!

[JerryD]

Great post, Marco. You answer many questions I have seen posted, on this site, before. Good luck

[Marco]

I'm glad some of you are finding the information useful. I just reread it and found the grammatical and spelling errors frightful. They need to invent a better spell checker!

ru4cats - thanks for the link. I had not seen it yet.

I wish you all well ...

[Seasha]

Thank you Marco! I moved this to the Medication & Treatment forum and made it into a sticky.

Bless you!

[coral63]

Thank you so much. Great information presented in easy to understand terms. You put forth great effort and I appreciate your time and talents.