Disease Modifying Drugs

There are three types of Disease Modifying Drugs (DMDs) used in the treatment of MS. These are:

• Beta interferon- which comes in two forms, Beta interferon 1a and Beta interferon 1b
• Glatiramer acetate ( Copaxone)
• Tysabri (natalizumab)

To learn more about each of the drugs available please go to Disease Modifying Drugs

To find out more about ongoing research with each of these drugs please go to  - Disease Modifying Drugs Ongoing Research

To find out general news about Disease Modifying Drugs please go to Disease Modifying Drugs Ongoing News

Tysabri^® User Diaries
To aid those who may have been prescribed Tysabri^® or those thinking of asking their Neurologist to prescribe Tysabri^® we at the MSRC have enlisted the help of a number of people with MS who are now currently taking Tysabri^® to provide some insight into how they went about getting given the drug and how the monthly infusions have changed, or not, their condition via their Tysabri^® User Diaries

If you are currently taking Tysabri^®, and would like to join our panel of "Diarists" please contact the MSRC Webmaster at squiffy@msrc.co.uk

Since 2002 the UK Government has run a Risk-Sharing Scheme For Disease Modifying Treatments For MS (Beta Interferon 1a & 1b and Glatiramer acetate) in conjunction with the pharamceutical companies supplying the drugs and the UK Health Authorities.

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Less than 50% of MS patients continually adhere to drug therapies

Disease-modifying drugs (DMDs) are injected medications used to slow the progression of multiple sclerosis (MS), and have been shown to reduce the frequency and severity of relapses. But according to a new study led by St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES), adherence to all DMDs is low, with less than half of patients, or 44 per cent, continually adherent after two years.

"There are a number of reasons why adherence to therapies of proven value might be low," says Dr. Paul O'Connor, director of the MS Clinic at St. Michael's Hospital. "These drugs don't work in everyone and some patients may stop them because they don't feel they are experiencing benefits. In some cases, patients may stop treatment because of side-effects. It is important that patients understand the need for continuing treatment in order to prevent some of the long-term consequences of MS."

The study, published in the May edition of The Canadian Journal of Neurological Sciences, aimed to determine differential adherence to these drugs in Ontario given that they are each marketed as differential efficacy, side effects, or convenience.

The study found:
682 Ontarians filling prescriptions through Ontario's Public Drug Programs were newly treated with a DMD for MS between April 2006 and March 2008
Although DMDs differ with respect to frequency of injection, costs and side-effect profiles, there is no indication that adherence to these medications varies substantially in Ontario.

Despite their efficacy, adherence to all DMDs is low, with less than half of patients (44 per cent) continually adherent after 2 years.

"This study shows that adherence to treatment with DMDs is low, which is concerning given their proven effectiveness in slowing the progression of MS. We need to increase the appreciation of the long-term benefits of these medications to ensure that MS patients are receiving the best treatment available," says co-author Tara Gomes, an epidemiologist at ICES.

The use of these drug therapies for the treatment of MS has risen 30 per cent between 2002 and 2007, with associated costs rising from $187 to $287 million in Canada.

Source: Medical News Today © MediLexicon International Ltd 2004-2011 (11/05/11)

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Could dodecylmaltoside inhibit Interferon-beta-1b neutralizing antibodies

Summary: A group from John Hopkins report initial findings of the success of the compound, dodecylmaltoside, a nontoxic alkylsaccharide surfactant, at reduce aggregation of interferon-beta in vitro.

The researchers suggest that by preventing aggregation of interferon-beta, formation of neutralizing antibodies may be prevented. In experiment where mice were given interferon-beta with and without dodecylmaltoside, it was also found to reduce the immunogenicity in vivo. The authors suggest the results warrant additional tests of dodecylmaltoside as a therapeutic adjuvant in rodent models of multiple sclerosis.

Abstract
The development of neutralizing antibodies to the protein drug interferon-β is a significant impediment to its use in the treatment of multiple sclerosis.

Neutralizing antibodies to interferon-β arise from aggregation of the peptide during manufacturing and storage.

We tested the ability of dodecylmaltoside, a nontoxic alkylsaccharide surfactant, to reduce aggregation of interferon-β in vitro and to reduce its immunogenicity in vivo.

Interferon-β, in solution with and without dodecylmaltoside, was periodically evaluated for aggregation by light scatter for 1 month. Interferon-β, with and without dodecylmaltoside, was given 3 days/week for 1 month to mice; the sera of these mice were analyzed for anti-interferon-β antibodies by ELISA.

Dodecylmaltoside reduces the aggregation of interferon-β in vitro and its immunogenicity in vivo. Our positive findings warrant additional tests of dodecylmaltoside as a therapeutic adjuvant in rodent models of multiple sclerosis.

Rifkin RA, Maggio ET, Dike S, Kerr DA, Levy M.

Department of Neurology, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology Building, Room 506, Baltimore, MD

Sources: J Neuroimmune Pharmacol. 2011 Mar;6(1):158-62 & Pubmed PMID: 20532646 (17/02/11)

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The present efficacy of multiple sclerosis therapeutics: Is the new 66% just the old 33%?

Many authorities, and of course the drug companies responsible, promote Tysabri as being more effective than standard disease modifying drugs (DMDs) like Betaferon (Betaseron) and Copaxone.

Klawiter and Cross, in the journal Neurology, argue that the risk of progressive multifocal leukoencephalopathy (PML) with Tysabri means that we have to examine this much more rigorously.

In their paper, entitled 'The present efficacy of multiple sclerosis therapeutics: is the new 66% just the old 33%?' (referring to the supposed better performance of Tysabri in relapse rate reduction than standard DMDs), they argue that because patient populations were markedly different in the trials, with patients with more benign illness in the Tysabri trials, the improved performance of Tysabri may be just an illusion, and it may in fact be comparable in efficacy with the DMDs.

ABSTRACT
A challenge for the clinician treating patients with multiple sclerosis (MS) is to determine the most effective treatment while weighing the benefits and risks. Results of the phase 2 and phase 3 studies on natalizumab were received with great interest, in part due to the “improved” risk reduction for relapse rate, disease progression, and MRI metrics observed in comparison to results in
trials of beta-interferon and glatiramer acetate. However, comparison across trials is invalid, in large part due to differences in the study populations. The increased efficacy observed in more recent trials has also been attributed to a fundamental change in subjects with MS enrolled in recent trials compared with the prior decade. In this article, we debate the relative efficacy of natalizumab vs the older injectable therapies.

Eric C. Klawiter, MD; Anne H. Cross, MD; Robert T. Naismith,MD

Sources: Neurology® 2009;73:984–990 & Taking Control Of Multiple Sclerosis (23/11/09)

© Multiple Sclerosis Resource Centre