Written By Julie Stachowiak, Ph.D.,
It looks like the time when oral MS drugs will be available is getting closer, maybe even measured in months. Clearly (and unfortunately), not all of us have the option of switching, since the oral candidates at this time (fingolimod and cladribine) are for relapsing-remitting multiple sclerosis.
However, for those of us that do have the option of switching from an injectible disease-modifying therapy for our MS, I pose the questions:
- Are you going to switch as soon as you can?
- Why or why not?
- What do you think your doctor will say?
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2 comments:
I have been on the trial for fingolimod and just finished my two years and went into the extension study where you know for sure that you are getting the meds and not a placebo. I have loved it! I have not had any exaserbations while on the oral therapy and for me it has been so much easier. When I was first diagnosed I was on Betaseron and unfortunately I had many side effects. I switched to Copaxone and the only side effects I had were the issues with injection site irritations. Though this was worse on Betaseron, I did still have issues with that with the Copaxone. My skin is just very sensitive to the injections I guess but it was begining to get harder for me to find spots that were not irritated to inject in. When my doctor referred me for the trial I figured why not. I don't usually put myself out to be a guinea pig but they are very good about monitoring with this trial and the only issue that I must concern myself with the most is that my immune system is somewhat compromised and I do need to watch the kind of situations I put myself in when considering exposure to people who are sick. I do have two children who come home from school sick and of course my exposure is increased because of this. I have not had any problems with getting sick excessively though and outside of the occasional cold or virus there has been nothing major. I am very very happy with my choice to take the oral therapy but of course everyone has to talk with their doctor and make the best choice for them.
Christine
At the CMSC (Consortium of MS Centers) conference in June in San Antonio, we got a good look at the two closest oral drugs to FDA approval. Both have higher side effect profiles than any of the 4 injectables on the market. Both have had 2 deaths in subjects in trials (this is a higher percentage than even Tysabri with PML). Herpes infections seem to be the culprit in both of these drugs.
With Fingolimod, taken daily, it can be "washed" out of the system within a month if problems develop whereas with Cladribine (immunosuppression lasts 12-18 months and to date is not reversible) there is no way to bring blood levels back up once you have taken the initial dosing and become immunosuppressed.
For these reasons, the general concensus at the conference was that when they are approved, neither will be lightly prescribed and they will not be offered as a first line drug to patients not on therapy. The target group for these two drugs are persons with RRMS who have tried the CRAB meds and failed them and have tried (or are not a candidate for) Tysabri and Novantrone and been unsuccessful. These are a NEXT line of defense drug.
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