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Eur J Neurol. 2014 Mar;21(3):377-87, e18-20. doi: 10.1111/ene.12299. Epub 2013 Nov 15.

Treatment options for patients with multiple sclerosis who have a suboptimal response to interferon-β therapy.

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1
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.

Abstract

BACKGROUND AND PURPOSE:

Although the first-line disease-modifying therapies (DMTs) interferon beta and glatiramer acetate have a favourable benefit-to-risk profile, they are only partially effective for treating relapsing-remitting multiple sclerosis (RRMS). The optimization of treatment in patients who do not show a maximum response to first-line therapy is critical for achieving the best long-term outcomes. Treatment strategies for patients with a suboptimal response include switching to another first-line DMT or a second-line DMT. Natalizumab and fingolimod are approved for RRMS with high disease activity in the European Union and Canada.

METHODS:

A comprehensive literature search for articles published between 1990 and April 2012 was undertaken.

RESULTS:

This review discusses key clinical and safety data for fingolimod and natalizumab, particularly in the patient subgroups for whom these treatments are approved. Benefit-to-risk profiles, including first-dose cardiovascular effects associated with fingolimod and the risk of progressive multifocal encephalopathy with natalizumab, are discussed.

CONCLUSION:

A descriptive comparison of fingolimod and natalizumab is provided in the context of the decision-making process of how and when to switch patients who have a suboptimal response to first-line therapy.

KEYWORDS:

disease-modifying drugs; fingolimod; natalizumab; relapsing-remitting multiple sclerosis; treatment failure; treatment strategy

PMID:
24237582
DOI:
10.1111/ene.12299
[Indexed for MEDLINE]
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