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

2. Treatment Available
1. Injectables
2. Orals
3. Infusion

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

4. 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

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

6. 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

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

8. 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

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

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

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

12. Which one suits me?

13. Which one suits me?

14. 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

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

16. In summary
Personal
Disease Drug

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

18. Questions and answers …