Risk Mitigation Strategies for Adverse Reactions Associated with the Disease-Modifying Drugs in Multiple Sclerosis

Abstract

Over the past several years the number of disease modifying therapies (DMTs) have doubled in number. The thirteen approved agents have shown a wide-range of efficacy and safety in their clinical trials and post-marketing experience. While the availability of the newer agents allows for a wider selection of therapy for clinicians and patients, it requires careful understanding of the benefits and risks of each agent. Several factors such as the medication efficacy, side-effect profile, patient’s preference, and co-morbidities need to be considered. An individualized treatment approach is thus imperative. In this review, risk stratification and mitigation strategies of the various disease modifying agents will be discussed.

ECTRIMS/EAN Guideline on the pharmacological treatment of people with multiple sclerosis

“…However, the variety of mechanisms of action, monitoring requirements and risk profiles together with the existing knowledge gaps make individualized medicine a complex task. 12,13 There is still controversy about the relative efficacy of the drugs available, who should receive therapy and the optimum time to start. The heterogeneity of MS together with the changes in the diagnostic criteria over the years [14][15][16][17] and the recent redefinition of the clinical subtypes 18 hamper direct comparisons across studies for different drugs.…”

Comorbid autoimmune pathology in patients treated with disease modifying drugs

“…В настоящее время в мире используется 13 ПИТРС, причем в ближайшее время их число, по-видимому, будет увеличиваться [17]. При обсужде-нии их роли в повышении риска развития комор-бидной патологии следует учитывать, что современ-ные препараты обладают более сильным иммуномо-дулирующим действием по сравнению со средства-ми предыдущих поколений.…”

Reduce the risk of adverse events associated with disease-modifying therapies for multiple sclerosis by following appropriate mitigation strategies

“…With the introduction of interferon-b in 1993, the management of patients with multiple sclerosis (MS) changed from a diagnostic and symptomatic treatment approach to a focus on disease modification [1]. In recent years, the number of approved disease-modifying therapies (DMTs) for MS has increased, widening the options available to clinicians and patients.…”

“…In recent years, the number of approved disease-modifying therapies (DMTs) for MS has increased, widening the options available to clinicians and patients. However, the benefits and risks (particularly that of the newer agents) must be carefully considered when designing the most appropriate treatment plan for each patient [1]. This article presents an overview of risk mitigation strategies for adverse effects associated for DMTs for MS, as reviewed by Subei and Ontaneda [1].…”