Diving Deeper with Oral MS Medications

MRIOver the past few years, new oral medications for multiple sclerosis have gained Food and Drug Administration (FDA) approval, giving patients treatment options beyond injectable forms of medication. With multiple sclerosis (MS) medications, one of the primary goals is to extend the time between relapses, which is why these medications are known as disease-modifying therapies.

Recently, researchers have reported on head-to-head comparisons of the two most prescribed oral MS medications: Gilenya (fingolimod) and Tecfidera (dimethyl fumarate, DMF). These first-ever direct assessments of oral MS drugs showed that fingolimod was better tolerated by patients than DMF.

Over the course of two years of treatment, discontinuation rates were lower in the group of 271 patients taking fingolimod, compared to the group of 342 patients taking DMF. Specifically, the chances of discontinuing treatment were 1.5 times higher in the DMF group by the end of two years, generally due to tolerability issues (e.g., gastrointestinal upset).

Similar outcomes – that is, more discontinuation from DMF than from fingolimod, as well as longer time to relapse in the fingolimod group – were reported by another research group from the Cleveland Clinic, based on 775 patients tracked over 12 months.

Another key finding: patients on fingolimod showed lower risk of MS lesions, as tracked by brain MRI. In fact, the DMF group had three times the number of lesions seen on MRI, which can be an indication of less well-controlled MS.

Together these studies point to a slight superiority of fingolimod over DMF, although none of the researchers suggest that a patient who is currently tolerating DMF should switch medications, as both remain highly efficacious and sound treatment choices for multiple sclerosis.

Sources

Real-world study gives glimpse of how two oral MS drugs stack up. Cleveland Clinic June 22, 2016.

Brooks M. Fingolimod easier to swallow than dimethyl fumarate? Medscape April 20, 2016.

Vollmer B, Nair K, Sillau S, et al. Comparison of fingolimod and dimethyl fumarate in the treatment of multiple sclerosis: Two year experience. Neurology 2016;86(16):Supplement S24.

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