M S Freedman1. 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.
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.
Authors: Bonaventura Casanova; Isidro Jarque; Francisco Gascón; Juan Carlos Hernández-Boluda; Francisco Pérez-Miralles; Javier de la Rubia; Carmen Alcalá; Jaime Sanz; Javier Mallada; Angeles Cervelló; Arantxa Navarré; María Carcelén-Gadea; Isabel Boscá; Sara Gil-Perotin; Carlos Solano; Miguel Angel Sanz; Francisco Coret Journal: Neurol Sci Date: 2017-04-10 Impact factor: 3.307
Authors: M S Freedman; J S Wolinsky; P Truffinet; G Comi; L Kappos; A E Miller; T P Olsson; M Benamor; S Chambers; P W O'Connor Journal: Mult Scler J Exp Transl Clin Date: 2015-12-07