Michaela asks Dr. Carolyn Young what one needs to consider before changing to an oral MS treatment.
Michaela: One of the website users has been on Avonex since 2004 and is thinking about changing to an oral treatment, what do they need to consider?
Professor Carolyn Young, Neurologist: Right, so Avonex is one of the beta interferons and it’s given by an intramuscular injection once a week, so we do appreciate that even if a patient is doing well on the drug, they might want to move away from having to do regular intramuscular injections, particularly nowadays, because there are orals or tablet forms of treatment available. So there are three main choices for the tablet treatments. In no particular order, there’s dimethyl fumarate, which is trade name Tecfidera. There’s fingolimod, trade name Gilenya, and there’s teriflunomide, trade name Aubagio. And they’re made by three different companies. So they’re all approved for the treatment of relapsing remitting MS to reduce the frequency of relapses. One of the ways we assess drugs is looking at their number needed to treat, and they’re about the same for all of those.
Michaela: And what are the side effects to these?
Professor Carolyn Young: So that’s a really important question. Since the number needed to treat is about the same for all three drugs, at about five or six people who’d need to take the medication for a year to have one relapse saved between them, then side effects are important, and those differ quite a bit between these tablets. So just dealing with some of the important side effects, again in no particular order. Gilenya, or fingolimod can rarely cause changes in the rate of the heart beating, can slow it down a little bit, and can cause a change at the back of the eye, called macular edema. Exceptionally rarely it also can lead to something called PML, which is a serious brain infection. Rarely, PML can also occur with Tecfidera or dimethyl fumarate, but a more common side effect with that medication would be some flushing and some abdominal discomfort, particularly early on whilst the patient’s adjusting to the drug. And finally then with teriflunomide or Aubagio, the commonest side effects would be about 15% might get a bit of diarrhoea and about ten per cent have temporary hair thinning. So they’re really quite diverse and it’s worth discussing the pros and cons of each medication with the doctor.
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