Update on oral treatments for MS
The annual meeting of the European Committee for Treatment and Research in MS (ECTRIMS) concluded earlier this month and provided a wealth of new information about the MS treatments that are often used as starting therapy.
One of the few studies of injectable medications reported what is widely known – that it is difficult to stick with the treatment plan when you have to inject yourself regularly. The study looked at 3,964 MS patients registered in the U.S. and Europe (Lee and colleagues. ECTRIMS 2021; abstract P847). Most were taking Betaseron/Extavia, Copaxone or Plegridy. About 1 in 3 experienced side effects, such as injection site reactions and flu-like symptoms. Over time, about 75% of people ultimately switched to another treatment, often because they were tired of injecting themselves.
People appear to fare much better if they are treated with an oral therapy, either Aubagio or Tecfidera. In the TeriCARE study, over a 2-year period, the proportion of people taking Aubagio who were employed increased from 56% to 62%, and the average number of lost work hours per week decreased from 17 hours to 10 hours (Caminero Rodriguez and colleagues. ECTRIMS 2021; abstract P849). Much of this effect appeared to be due to improvements in fatigue and depression. A second employment study suggested that the cognitive impairment that can occur in MS was stabilized during treatment with Aubagio, which may help people stay on the job (Unverdi and colleagues. ECTRIMS 2021; abstract P076).
Two studies also reported on quality of life with Aubagio. The AURELIO study in Greece found that most people taking Aubagio were satisfied with their medication and said their quality of life did not get worse on treatment, although 1 in 4 stopped taking the drug within the first two years. (Dardiotis and colleagues. ECTRIMS 2021; abstract P854 and P876). About one-third reported side effects but these were generally mild. In the TERI-REAL study in Hungary, people taking Aubagio reported improvements in their general health, social and sexual function and energy levels (Vecsei and colleagues. ECTRIMS 2021; abstract P863). About 1 in 3 stopped treatment over the two-year study.
The other oral therapy that is commonly prescribed is Tecfidera. The general impression is that Tecfidera is somewhat stronger than Aubagio – and idea that a study in Switzerland examined (Muller and colleagues. ECTRIMS 2021; abstract P819). The researchers compared people in the Swiss National Registry who had taken Aubagio or Tecfidera over a 7-year period. While the two treatments were similar, people taking Aubagio were more likely to experience a relapse sooner and to have worsening disability earlier than those on Tecfidera, suggesting that Tecfidera is more effective at controlling the MS disease process.
In a longer term study in Sweden, relapses were uncommon among people on Tecfidera (Rosengren and colleagues. ECTRIMS 2021; abstract P735). People also reported that their MS symptoms improved during treatment. A limitation, however, was that in the larger sample of people starting Tecfidera, many people stopped their medication before the 5-year mark.
In a study from the ESTEEM trial, researchers looked at people who had been taking Tecfidera after switching from an injectable medication (Giles and colleagues. ECTRIMS 2021; abstract P269). After starting Tecfidera, about 75% experienced no relapses for up to five years. The most common side effect associated with stopping treatment was gastrointestinal upset.
Stomach symptoms can be a problem for some people taking Tecfidera, which has led to the development of a sister drug called Vumerity (approved in the U.S., pending in Canada and Europe). The EVOLVE-MS-2 trial compared the two drugs in over 500 people and found that stomach symptoms were less common and less often severe with Vumerity compared to Tecfidera (Naismith and colleagues. ECTRIMS 2021; abstract P692). As a result, more people stopped taking Tecfidera compared to Vumerity (5% vs. 1%). Flushing – the other common side effect with this class of drug – occurred somewhat less often with Vumerity compared to Tecfidera (46% vs. 55%) in an analysis from that same study (Singer and colleagues. ECTRIMS 2021; abstract P673).
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