Title:Immune Therapy of Multiple Sclerosis - Future Strategies
Volume: 18
Issue: 29
Author(s): Sven G. Meuth, Kerstin Gobel and Heinz Wiendl
Affiliation:
Keywords:
Multiple sclerosis, cladribine, fingolimod, BG00012, laquinimod, teriflunomide, alemtuzumab, daclizumab, disease-modifying therapies (DMTs), IFN β.
Abstract: Baseline disease-modifying therapies (DMTs) for multiple sclerosis (MS) include three different preparations of interferonbeta
(IFN-β) and glatiramer acetate (GA). These substances reduce relapse rates, side-effects are tolerated by most patients and - after
more than 15 years of experience - the long-term safety profile for these drugs can be appraised as very good. In 2006, the therapeutic
tool kit was augmented by the first monoclonal antibody, natalizumab, approved as monotherapy for treatment-refractory highly active
MS. The restriction to these patient groups results from the rare, but fatal risk of JC virus-induced progressive multifocal leukoencephalopathy
(PML). The first oral agent (fingolimod) was approved in 2010 for the United States and in 2011 for Europe. As a further option
for therapy escalation the chemotherapeutic agent mitoxantrone is approved for non-responding relapsing-remitting MS (RRMS) or secondary
progressive MS (SPMS). The use of mitoxantrone is limited by severe cardiotoxicity and the risk of treatment related acute leukemia.
However, despite the fact that therapeutic options for MS have significantly been widened over the past decade new treatment options
and more convenient modes of application are needed to enhance efficacy and improve adherence to therapy. This article will review recent
developments in MS treatments focusing on oral agents (cladribine, fingolimod, BG00012, teriflunomide and laquinimod) and novel
monoclonal antibodies (alemtumzumab, daclizumab, ocrelizumab, ofatumumab).
