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Symposium at ECTRIMS 2015 – Long-term benefits versus potential risks: The Balancing Act

Alexandre Prat


The satellite symposium was sponsored by Merck KGaA, Darmstadt, Germany

Dr. Prat discussed the selection of drugs for the treatment of multiple sclerosis.Therapy choices must be based on adequate disease control, safety, tolerability, adherence, safety monitoring and concomitant medication. Therapy must consider adequate control of relapses

More aggressive or radical therapies with more severe side effects are rarely needed in MS. Dr. Prat summarised the therapeutic possibilities as follows

First line therapy:

IFN beta upregulates anti-inflammatory cytokines, down regulates pro-inflammatory cytokines, and reduces inflammatory cell migration across the blood brain barrier. The most frequent AEs are flu-like syndrome and injection site reactions. Teriflunomide is a non-cytotoxic antiproliferative agent, through inhibition of pyrimidine synthesis. AEs include headache diarrhea and nausea. Dimethyl fumarate reduces proliferation of leukocytes and suppresses proinflammatory cytokines. It may be associated with flushing, diarrhea, nausea, vomiting and lymphopenia.

Second line therapy:

Natalizumab inhibits lymphocyte trafficking across the blood brain barrier. There is an increased risk of PML and herpes infections. Fingolomid is a prevents memory T-cells from circulating to the CNS and lymphocytes from leaving lymph nodes. It has been associated with PML, cancer and lymphopenia. Alemtuzamab depletes lymphocyte populations. There is a risk of cancer and opportunistic infections.

Dr. Prat emphasised that the first line therapies IFN and GA have been used for 20 years, with extensive clinical experience.Longer exposure is needed for the new oral DMDs. When considering the use of DMDs, clinicians and patients must balance efficacy against potential side effects for all agents. 

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