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Abstract
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.
Glossary
- ARR=
- annual relapse rate;
- EAE=
- experimental allergic encephalitis;
- EDSS=
- Expanded Disability Status Scale;
- FDA=
- Food and Drug Administration;
- IFN=
- interferon;
- MS=
- multiple sclerosis;
- MSFC=
- MS Functional Composite;
- Nrf2=
- nuclear factor-E2-related factor 2;
- RRMS=
- relapsing-remitting MS;
- SC=
- subcutaneously;
- S1P=
- sphingosine-1-phosphate.
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