Treatment of Multiple Sclerosis: Old & New

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Presentation transcript:

Treatment of Multiple Sclerosis: Old & New Victor Chong Multiple Sclerosis Clinic, Monash Medical Centre

Treatment Available 1. Injectables 2. Orals 3. Infusion

Injectables Interferon-β Avonex Plegridy Betaferon Rebif Glatiramer acetate (Copaxone)

Injectables Old, safe and reliable Work by tweaking the immune system Flu-like symptoms, injection site reactions Serious adverse reactions are rare Not the most effective

Orals 1. Fingolimod (Gilenya) 2. Dimethylfumarate (Tecfidera) 3. Teriflunomide (Aubagio) 4. Cladribine (Mavenclad)

Orals 1. New, effective and convenient 2. Works by suppressing immune system 3. Gastrointestinal, liver, low white cells count 4. Serious side effects uncommon 5. Good efficacy

Infusions 1. Natalizumab (Tysabri) 2. Ocrelizumab (Ocrevus) 3. Alemtuzumab (Lemtrada)

Infusions 1. Powerful and hard hitting 2. Works by killing immune cells or interfering with their function 3. Immunosuppression, infections, other immune diseases 4. Most effective treatment

Why do some drugs work for months, others only hours?

Natalizumab (Tysabri) Works by blocking immune cells from entering the brain

Cladribine, Ocrelizumab & Alemtuzumab Works by killing blood cells Kills off CD4+, CD8+ CD19+, CD56+

Which one suits me?

Which one suits me?

How do we choose? Patients who don’t do well: 1. Older 2. Male 3. Smoker 4. Frequent attacks 5. Severe attacks 6. Incomplete recovery 7. Critical area scarring on MRI 8. Brain shrinkage

Other considerations … Personal Factors: 1. Life style & work 2. Risk adversity 3. Concerns 4. Preferences 5. Family plans

In summary Personal Disease Drug

Monitoring Regular check-ups for 1. Side effects 2. Efficacy 3. Disease progression 4. Changing treatment

Questions and answers …