Disease-modifying treatments for multiple sclerosis - a review of approved medications

Abstract

Background and purpose: There is still no curative treatment for multiple sclerosis (MS), but during the last 20 years eight different disease-modifying compounds have been approved for relapsing-remitting MS (RRMS).

Methods: A literature search was conducted on published randomized controlled phase III trials indexed in PubMed on the approved medications until 21 May 2015.

Results: In this review the mode of action, documented treatment effects and side effects of the approved MS therapies are briefly discussed.

Conclusions: Based on current knowledge of risk-benefit of the approved MS medications, including factors influencing adherence, it is suggested that oral treatment with dimethyl fumarate or teriflunomide should be preferred as a starting therapy amongst the first-line preparations for de novo RRMS. In the case of breakthrough disease on first-line therapy, or rapidly evolving severe RRMS, second-line therapy with natalizumab, fingolimod or alemtuzumab should be chosen based on careful risk-benefit stratification.

Keywords: disease-modifying; multiple sclerosis; review; treatment.

Figure 1

Treatment algorithm for treatment-naïve patients with RRMS. *Patients with rapidly evolving severe RRMS should start directly on a second-line therapy. Breakthrough disease activity is defined as one new clinical relapse with significant influence on disability and/or new signs of radiological disease activity (≥3 active MRI lesions) during the last year whilst on first-line medication.