Update on MS medications
Report from the American Academy of Neurology annual meeting, Los Angeles CA, April 21-27, 2018 – Doctors have now accumulated a great deal of experience with the newer MS medications. Here is a summary of long-term data for four of the medications commonly used to treat MS.
Aubagio: People in the original phase 3 studies of Aubagio have now been treated for up to seven years. Relapses are uncommon, and 75-94% of people have had no relapses in any given year (Oh and colleagues. AAN 2018; abstract P6.391). About 74% of people had no worsening of their disability over the first five years of treatment (Krieger and colleagues. AAN 2018; abstract P6.374). Overall, about 18% of people haveexperienced serious side effects, with about 14% stopping treatment because of them. A separate study looked at people who had been taking Aubagio for up to 14 years (Freedman and colleagues. AAN 2018; abstract P6.389). After 10 years, the average level of disability was lower than it was when people started treatment; about 70% showed no worsening in their disability, indicating that MS can be well-controlled over the longer term in many people.
Tecfidera: Eight-year data are now available for people originally enrolled in the Tecfidera studies (Gold and colleagues. AAN 2018; abstract P6.382). In the group for whom Tecfidera was their first treatment, about 55% have continued on therapy for 8 years. Relapses are uncommon, and 92% of people have little or no disability. In the ESTEEM study of people treated at MS clinics (as opposed to a clinical trial), about 89% of people taking Tecfidera didn’t have a relapse in their first year of treatment (Calkwood and colleagues. AAN 2018; abstract P6.373).
Gilenya: The LONGTERMS study is pooling the results from over three thousand people enrolled in various Gilenya trials, with people on treatment for 5 years on average (Tenenbaum and colleagues. AAN 2018; abstract P6.377). Overall, about 80% haven’t had any worsening of their disability, and 71% continue to have minimal disability. About 13% have experienced a serious side effect, most commonly an upper respiratory tract infection or headache. A separate study looked at younger people taking Gilenya for up to 8 years (Chitnis and colleagues. AAN 2018; abstract P6.385). Relapses remained uncommon at the 8-year mark and there was a 54% lower risk of developing disability compared to those on no treatment.
Mavenclad: This newest addition to the list of MS medications has been in development for the past decade, so 8-year safety data are available (Cook and colleagues. AAN 2018; abstract P6.407). Like Lemtrada and Ocrevus, Mavenclad reduces the number of immune cells in the body as a way of controlling MS. In consequence, there is a somewhat higher risk of infections, most often of the respiratory tract. The highest risk (about 13% per year) is in the month after dosing, when blood cell counts are lowest. There is also a risk of developing shingles, although the risk of this occurring is low (about 4% per year).
Lemtrada: The TOPAZ study is following people from the original trials and 7-year results are now available. Among those whose first treatment was Lemtrada, after receiving the full course of treatment (5 days in year 1, 3 days in year 2), 59% didn’t need additional treatment over the next 5 years (Vermersch and colleagues. AAN 2018; abstract P6.376). Overall, 74% showed no worsening of their MS and 37% showed some improvement. In the group who had been previously treated with another medication prior to Lemtrada (so their MS was more difficult to treat), 47% needed no further treatment after Lemtrada over the next 5 years (Singer and colleagues. AAN 2018; abstract P6.369). Relapses were uncommon and 51% had no relapses in years 3-7 (i.e. after their last dose). By the end of the 7-year period, 69% had no worsening of their disability and 44% showed some improvement. These results indicate that after completing the two-year course of Lemtrada, many people can remain medication-free for the next five years. Two separate studies also reported that people who do need a third course of treatment will still respond to the drug (Boster and colleagues. AAN 2018; abstract P6.362. Singer and colleagues. AAN 2018; abstract P6.363). The relapse rate goes down and the level of disability stabilizes, although a lower percentage of people show improvement in their disability. Overall, 39-45% of people completing the two years of Lemtrada therapy needed a third course of treatment. So a majority of people won’t need more MS drugs for five years after completing their course of Lemtrada.
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