Dr. Thomas: Doctors are now faced with a variety of different options for patients newly diagnosed with MS or existing MS patients. One new medication, alemtuzumab—it's very interesting to a neurologist. If that were to be approved, I think people will look at alemtuzumab as they do with natalizumab: It's clearly more effective [than current first-line injectables], but it clearly has safety issues.1-3
Narrator: Indeed, recently presented data from the CARE-MS I trial in treatment-naïve patients with relapsing-remitting MS, show 55% greater reductions in relapse rate compared with interferon β-1a (P < .0001), but a higher incidence of infections (67.3% of alemtuzumab patients versus 45.5% of interferon β-1a patients)—of predominantly mild-to-moderate severity; and a higher rate of autoimmune thyroid-related adverse events, 18.1% versus 6.4% with interferon β-1a.3
Dr. Thomas: The original studies looked wildly more effective even than natalizumab. Then the follow-up studies showed it was a little closer to natalizumab. I think neurologists are going to look for a safe alternative with a long track record first with a patient, if they can.
There isn't really one specific treatment which is appropriate for all patients. A large number of neurologists have a long experience with available injectable therapy. They feel comfortable with the monitoring requirements and the safety of the injectable therapies. So because of this, neurologists will continue to write for [current] injectable therapy as a first-line option for patients.
It's important that, as new treatments for MS come out, we don't forget about well-established treatments.4-9 The tried-and-true injectables still have a place, especially in a young patient, maybe of child-bearing age. Glatiramer acetate, in fact, is pregnancy category B. And certainly as time goes on, we'll have a better understanding of the safety issues associated with the newest medications. I think that there will be a lot of options in the future to continue with these injectable therapies.
Obviously, patients have to be willing to take an injectable therapy, but the new auto-injectors and smaller needle options help.