Emerging oral disease-modifying therapies

Over the last two decades, patients have relied on the use of self-injectable disease modifying agents for the treatment of multiple sclerosis. The need for frequent injections has affected treatment up take and adherence. Fingolimod, the first oral disease modifying agent to be licensed in Europe and the United States, has been shown to be effective in reducing relapse rates in comparison to placebo and once weekly low dose interferon b-1a (Avonex®) in relapsing remitting multiple sclerosis. Four other oral agents, currently in Phase III trials, have also shown promising results. Over the next few years, physicians may have up to five oral agents to choose from all of which may compete with currently available therapies in terms of efficacy, tolerance and ease of administration. However their cost, side effect profile and lack of long term efficacy and safety data are likely to limit their use in the short term. Despite the advantages of oral disease-modifying therapies, it is likely that currently available agents will continue to be the mainstay of treatment for the foreseeable future with the emerging oral therapies providing effective second line therapy.