Emerging multiple sclerosis oral therapies

Currently, patients suffering from multiple sclerosis (MS), a chronic demyelinating disorder of the CNS, must be injected with medication to provide modest relief for their symptoms. Five orally available therapies are being evaluated in phase II/III clinical trials. If these therapies prove safe and tolerable, oral compounds may improve patient endorsement and compliance. Fingolimod, a novel immunosuppressant, significantly lowered annual relapse rates in phase II/III trials. Laquinimod, an immunomodulator, reduced the cumulative number of active lesions at the highest dose tested (0.6 mg/d) in a phase II trial. Cladribine, another immunomodulator, reduced annual relapse rates by >50% and gadolinium-positive lesions by >70% at both doses tested in a phase III trial. Oral fumarate, with immunomodulatory and antioxidant properties, also lowered the number of lesions in a phase II trial. Finally, teriflunomide, an immunomodulator, significantly reduced MRI lesion activity and reduced annual relapse rates in a phase II trial. In this report, we weigh the beneficial outcomes of these compounds against their risks of adverse effects. NEUROLOGY 2010;74(Suppl 1):S47-S53