Immune therapy of multiple sclerosis--future strategies

• Published in: Current pharmaceutical design Vol. 18; no. 29; p. 4489
• Main Authors: Meuth, Sven G, Göbel, Kerstin, Wiendl, Heinz
• Format: Journal Article
• Language: English
• Published: United Arab Emirates 01.10.2012
• Subjects: Animals; Antibodies, Monoclonal - immunology; Antibodies, Monoclonal - therapeutic use; Disease Models, Animal; Drug Approval; Drug Design; Europe; Humans; Immunologic Factors - adverse effects; Immunologic Factors - pharmacology; Immunologic Factors - therapeutic use; Medication Adherence; Multiple Sclerosis - drug therapy; Multiple Sclerosis - immunology; Multiple Sclerosis - physiopathology; United States; United States; Europe
• ISSN: 1873-4286
• DOI: 10.2174/138161212802502198

Baseline disease-modifying therapies (DMTs) for multiple sclerosis (MS) include three different preparations of interferon-beta (IFN-β) and glatiramer acetate (GA). These substances reduce relapse rates, side-effects are tolerated by most patients and - after more than 15 years of experience - the long-term safety profile for these drugs can be appraised as very good. In 2006, the therapeutic tool kit was augmented by the first monoclonal antibody, natalizumab, approved as monotherapy for treatment-refractory highly active MS. The restriction to these patient groups results from the rare, but fatal risk of JC virus-induced progressive multifocal leukoencephalopathy (PML). The first oral agent (fingolimod) was approved in 2010 for the United States and in 2011 for Europe. As a further option for therapy escalation the chemotherapeutic agent mitoxantrone is approved for non-responding relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS). The use of mitoxantrone is limited by severe cardiotoxicity and the risk of treatment related acute leukemia. However, despite the fact that therapeutic options for MS have significantly been widened over the past decade new treatment options and more convenient modes of application are needed to enhance efficacy and improve adherence to therapy. This article will review recent developments in MS treatments focusing on oral agents (cladribine, fingolimod, BG00012, teriflunomide and laquinimod) and novel monoclonal antibodies (alemtumzumab, daclizumab, ocrelizumab, ofatumumab).