Comparison of 14 DMTs for MS

[Apollo]

I created this list to give a limited comparison of current DMTs including the methods of delivery. The percentages are compared to placebo; for example, Copaxone reduces relapses by 30% compared to placebo and reduces lesions seen on MRI by 40% compared to placebo.

The percentages are approximate and most are from a presentation made by a British neurologist specializing in MS. The presentation can be found on YouTube by entering “DR MILLER ON DMT”. Numbers 1-12 are FDA approved for MS, #13 Rituxan is an FDA approved medicine for several disorders but is prescribed off-label for MS, #14 HSCT is experimental but demonstrates exceptional results according to published trials.

1. Copaxone… injection under the skin every other day
Reduces relapses………………….. 30%
Reduces new MRI lesions……… 40%

2. Avonex… (interferon beta-1a) muscle injection once a week
Reduces relapse……………………. 30%
Reduces new MRI lesions.…….. 60%

3. Rebif… (interferon beta-1a) injection under the skin 3 times a week
Reduces relapses………………….. 30%
Reduces new MRI lesions……... 60%

4. Pelgridy… (peginterferon beta-1a) injection every two weeks
Reduces relapses………………….. 30%
Reduces new MRI lesions……… 60%

5. Betaseron… (interferon beta-1b) injection under the skin every other day
Reduces relapses…………………… 30%
Reduces new MRI lesions………. 60%

6. Extavia… (interferon beta-1b) injection under the skin every other day
Reduces relapses……………………..30%
Reduces new MRI lesions…………60%

7. Novantrone (mitoxantrone) IV infusion
In 2000, mitoxantrone was approved for the treatment of worsening RRMS in patients whose neurological function remains abnormal between relapses, at a 12 mg/m2 IV dose administered every 3 months. It is also the only drug indicated for the treatment of SPMS and is approved for patients with PRMS.

8. Tysabri… (natalizumab) IV infusion every 4 to 8 weeks
Reduces relapses……………………. 70%
Reduces new MRI lesions……….. 90%

9. Gilenya… (fingolimod) oral capsule once a day
Reduces relapses……………………. 50%
Reduces new MRI lesions……….. 75%

10. Aubagio… (teriflunomide) oral tablet once a day
Reduces relapses……………………. 30%
Reduces new MRI lesions……….. 50%

11. Tecfidera… (dimethyl fumarate) oral capsule twice a day
Reduces relapses……………………. 50%
Reduces new MRI lesions……….. 70%

12. Lemtrada… (alemtuzumab) 5 IV infusions followed by 3 one year later
Reduction of relapses estimated at 80%
Reduction of new MRI lesions estimated at 70%

13. Rituxan … (rituximab) Variable # of IV infusions
This is prescribed off-label for MS. It is a highly effective treatment for MS (comparable to Tysabri) and it does not carry nearly the risk as Tysabri for a disease called PML. This is a very, very effective medicine which typically begins with 1-3 IV infusions followed by 1 or 2 infusions several weeks later.

14. HSCT (Hematopioetic Stem Cell Therapy) One time treatment
This is an experimental treatment which has proven extremely effective in patients with Relapsing Remitting MS (RRMS).

[Apollo]

I should have said, "reduces new lesions seen on MRI by 40% compared to placebo."

[Sparky10]

Nice to see the percentages increasing. I thought they were, but you've shown it easily.

I take Tecfidera; glad it's in the higher percentile.

[ActiveMSers]

Thanks Apollo! Obviously there is more to consider with a treatment than relapse and new lesion reduction (lessening brain atrophy, side effects, influence on QOL, treatment adherence, PML risk, etc.), but this is a good overview. I appreciate you putting it together, and those numbers look accurate (but for the record, note that I have not vetted).

[Apollo]

You are welcome.

I put this together for my niece who was recently diagnosed. It is an primitive introduction containing only a few points. The numbers, or percentages, are approximate. Often there are several trials of a drug and each drug trial has slightly different results so an average is provided.

Each person responds uniquely to therapies, Hopefully, everyone can find something that works for them, whether on the med list or an alternative.

I felt it worthwhile to provide a starting point for those considering treatments.

[myoak]

Indirect comparisons involving NEDA (No Evidence of Disease Activity)

NEDA is currently defined as having no relapses, MRI lesions and disability progression.

If brain shrinkage is added to those three as a fourth value, Gilenya would move up the list considerably well.

Patients with NEDA, No Evidence of Disease Activity Status, %. Various Studies cited.

Tysabri (natalizumab) 42% (AFFIRM Study 1 and 2 year combined stats)

Lemtrada (alemtuzumab) 35% (CARE-MS 1 and CARE-MS 2 Studies combined stats)

Gilenya (fingolimod) 33% (FREEDOMS Study, 2 years)

Tecfidera (dimethyl fumarate) 28% (DEFINE Study, 2 years)

Copaxone (glatiramer acetate) 19% (CombiRx multiyear study)

Since the ADVANCE study with Plegridy has only one year of stats and all MS meds listed here see a decrease of NEDA as time increases, the one year duration must be noted. For example, in the first year of the AFFIRM Tysabri study NEDA was 47% but in the second year of AFFIRM Tysabri NEDA was 37%. As stated, the listed MS meds see decreasing NEDA rates over time so they appear better at one year than at two on the NEDA chart.

Plegridy (peg interferon beta) 34% (ADVANCE Study, 1 year)

The above stats are taken from this website:

http://www.msdiscovery.org/news/new_...9D-ms-patients

Again, I have no interest in pushing any med but present info I believe important to Msers.

New data confirm high efficacy of Gilenya® in achieving 'no evidence of disease activity (NEDA)' based on four key measures of MS

http://www.novartis.com/newsroom/med.../1855482.shtml

Best thoughts