The treatment of multiple sclerosis (MS) is evolving beyond the current parenteral immunomodulators and early oral alternatives, offering physicians considerable choice of therapies. Although all agents are tested in similarly designed clinical studies, comparison of their outcomes is not possible except in carefully controlled head-to-head comparator studies. In this review, the current, recent, and most imminent therapies are discussed and an overall summary is presented along with a discussion of how they are perceived relative to the older or other recent agents.
The list of potentially effective agents for the treatment of MS may be exhaustive, but several have now completed their phase 3 trials and have received or imminently expect government approval. This review discusses these new agents in terms of their perceived mechanisms of action and their respective results, and attempts to position them among the currently approved and utilized agents for MS.
Although it is not yet possible to predict which treatment is best suited to a given patient, it is nevertheless important to have a perspective of the possible agents and their efficacy and safety, and a plan regarding how to use them in order to maximize benefit and minimize harm in controlling relapsing MS.
Address correspondence to Dr Mark S. Freedman, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada, firstname.lastname@example.org.
Relationship Disclosure: Dr Freedman has received honoraria from or serves as a consultant for Actelion Pharmaceuticals Ltd, Bayer HealthCare, Biogen Idec, Celegene Corporation, EMD Canada, Glycominds Ltd, Novartis, Sanofi-Aventis, and Teva Canada. Dr Freedman serves on the advisory boards or other similar boards of Actelion Pharmaceuticals Ltd, Bayer HealthCare, Biogen Idec, Celegene Corporation, Genzyme, Merck Serono, Novartis, Sanofi-Aventis, and Teva Canada Innovation. Dr Freedman receives research or educational grants from Bayer HealthCare and Genzyme Corporation.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Freedman discusses the unlabeled use of laquinimod, alemtuzumab, and ocrelizumab for the treatment of multiple sclerosis.