From the Guidelines
Multiple sclerosis (MS) treatment should prioritize disease-modifying therapies (DMTs) and regular MRI monitoring to track disease progression, as recommended by the most recent guidelines 1. The goal of treatment is to reduce relapses, slow progression, and manage symptoms. First-line medications include injectable options like interferon beta (Avonex, Rebif) and glatiramer acetate (Copaxone), oral medications such as dimethyl fumarate (Tecfidera), fingolimod (Gilenya), and teriflunomide (Aubagio), or infusion treatments like natalizumab (Tysabri) and ocrelizumab (Ocrevus) 1. Some key points to consider in MS treatment include:
- The use of autologous haematopoietic stem cell transplantation (AHSCT) as a treatment option for relapsing forms of MS that are refractory to DMT 1
- The importance of regular MRI monitoring to track disease progression and guide treatment decisions 1
- The need for individualized treatment approaches, taking into account disease severity, progression pattern, and individual factors 1
- The role of symptom management in addressing issues like fatigue, muscle spasticity, pain, and bladder dysfunction 1
- The importance of a neurologist specializing in MS overseeing treatment and care 1
From the FDA Drug Label
REBIF is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults. TYSABRI is indicated as monotherapy for the treatment of relapsing forms of multiple sclerosis, to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.
The treatment of multiple sclerosis can be done with:
- interferon beta-1a (SQ), with a recommended dose of either 22 mcg or 44 mcg injected subcutaneously three times per week 2
- natalizumab (IV), with a recommended dose of 300 mg intravenous infusion over one hour every four weeks 3 The indication for both interferon beta-1a (SQ) and natalizumab (IV) includes relapsing forms of multiple sclerosis, to include:
- clinically isolated syndrome
- relapsing-remitting disease
- active secondary progressive disease, in adults 2, 3, 2
From the Research
Disease-Modifying Therapies for Multiple Sclerosis
- The primary agents used in the United States for primary disease-modifying therapy in relapsing forms of multiple sclerosis (MS) include interferon beta1a (Avonex, Rebif), interferon beta1b (Betaseron), and glatiramer acetate (Copoxane) 4.
- Balancing efficacy versus burden of therapy is essential for the choice of disease-modifying therapy in every MS patient, with first-line therapies having well-established efficacy and presenting no major safety concerns 5.
- Interferon beta and glatiramer acetate have been mainstays of treatment in relapsing-remitting multiple sclerosis for two decades, with remarkable advances in understanding immune function and dysfunction 6.
Treatment Patterns and Efficacy
- High-dose interferon-beta (IFN beta)-1a or IFN beta-1b subcutaneous has a greater impact than weekly IFN beta-1a IM on several clinical and MRI outcomes 7.
- High-dose IFN beta-1a or IFN beta-1b subcutaneous has a similar clinical impact to glatiramer acetate, although IFN beta subcutaneous is superior on some MRI outcome measures 7.
- Patients with MS whose disease activity is inadequately controlled with a platform therapy may switch to another platform therapy or escalate therapy to natalizumab or fingolimod 8.
Patient Outcomes and Treatment Adherence
- Natalizumab initiators were more likely to stay on index therapy and have fewer treatment gaps of ≥ 60 days compared with platform initiators 8.
- Nearly 79% of platform initiators who switched went to another platform therapy, and approximately two thirds of patients who switched to a third DMT switched to another platform therapy 8.
- A total of 9% of natalizumab and platform initiators discontinued DMT within the 2 years 8.