The sequence of disease-modifying therapies in relapsing multiple sclerosis: safety and immunologic considerations

Gabriel Pardo, David E Jones, Gabriel Pardo, David E Jones

Abstract

The treatment landscape for relapsing forms of multiple sclerosis (RMS) has expanded considerably over the last 10 years with the approval of multiple new disease-modifying therapies (DMTs), and others in late-stage clinical development. All DMTs for RMS are believed to reduce central nervous system immune-mediated inflammatory processes, which translate into demonstrable improvement in clinical and radiologic outcomes. However, some DMTs are associated with long-lasting effects on the immune system and/or serious adverse events, both of which may complicate the use of subsequent therapies. When customizing a treatment program, a benefit-risk assessment must consider multiple factors, including the efficacy of the DMT to reduce disease activity, the short- and long-term safety and immunologic profiles of each DMT, the criteria used to define switching treatment, and the risk tolerance of each patient. A comprehensive benefit-risk assessment can only be achieved by evaluating the immunologic, safety, and efficacy data for DMTs in the controlled clinical trial environment and the postmarketing clinical practice setting. This review is intended to help neurologists make informed decisions when treating RMS by summarizing the known data for each DMT and raising awareness of the multiple considerations involved in treating people with RMS throughout the entire course of their disease.

Keywords: Multiple sclerosis; Re-treatment; Selection for treatment; Therapeutic drug monitoring; Treatment effectiveness.

Conflict of interest statement

Ethical standards

The manuscript does not contain clinical studies or patient data.

Conflicts of interest

G. Pardo is an advisor and on the speaker bureau for Biogen, EMD Serono, Genentech, Novartis, Sanofi Genzyme, and Teva. D. E. Jones has consulted for Biogen, Novartis, and Sanofi Genzyme, and received research or salary support from Biogen, the Consortium of Multiple Sclerosis Centers, and the National Multiple Sclerosis Society over the past 2 years.

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