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Oral available agents in the treatment of relapsing remitting multiple sclerosis an overview of merits and culprits

Authors Thöne J, Ellrichmann G

Received 8 October 2012

Accepted for publication 30 November 2012

Published 26 February 2013 Volume 2013:5 Pages 37—47

DOI https://dx.doi.org/10.2147/DHPS.S28822

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Jan Thöne, Gisa Ellrichmann

Department of Neurology, St Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany

Abstract: Multiple sclerosis (MS) is a chronic immunological disease of the central nervous system characterized by early inflammatory demyelination and subsequent neurodegeneration. Major therapeutic progress has occurred during the past decade, in particular since the introduction of immunomodulatory agents, however, MS is still an incurable disease. In addition, parenteral application of the currently licensed drugs is associated with injection-related adverse events (AEs) and low patient compliance. Thus, there remains an unmet need for the development of more effective and well tolerated oral therapies for the treatment of MS. A number of new orally administered agents including fingolimod, laquinimod, teriflunomide, cladribine, and BG-12 have been licensed recently or are currently under investigation in relapsing remitting MS patients. In multi-center, randomized, placebo-controlled phase III clinical studies, all of these agents have already shown their efficacy on both clinical disease parameters and magnetic resonance imaging-based measures of disease activity in patients with relapsing remitting MS. However, there are essential differences concerning their clinical efficacy and side-effect profiles. Additionally, the mechanisms by which these substances exert clinical efficacy have not been fully elucidated. In this article, we review the pharmaceutical properties of fingolimod, laquinimod, teriflunomide, cladribine, and BG-12; and their suggested mechanisms of action, clinical efficacy, and side-effect profiles.

Keywords: cladribine, fingolimod (FTY), fumaric acid esters (BG-12), laquinimod, teriflunomide

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