neuro · news · pharm

A pill for MS

First off, thanks to Chenoa, Lila, and MedZag for the kind words on the last post. It’s good to know that other people care about this stuff too.  I’ll keep you all updated in how the year goes.

Fingolimod
This is fingolimod; ain't it a beaut? (Image from Wikipedia)

In happier news, the FDA approved fingolimod in the treatment of multiple sclerosis! Up till now, MS treatment has been all intramuscular or intravenous. So this is an exciting step forward, to have an oral medication.  What’s more, a trial published in the New England Journal in February showed that fingolimod was actually superior to interferon in one-year follow-up. (PDF link; you’ll need Acrobat Reader and possibly a subscription to the NEJM.)

I had a patient with a new diagnosis of MS during my neurology sub-internship. (She had likely been living with the disease and its aftereffects for decades, but had never been diagnosed.) She was very squirrely around needles — we actually had to LP her under fluoroscopy because she couldn’t keep still.  My attending, resident, and I discussed her long-term medication plan, and I decided on weekly interferon as the best compromise between injections and relapses.  But I kind of want to track her down and say, “Look! We can do something to help you!”

Yes, yes, there may be long-term side effects.  In the trial, the high-dose of fingolimod was associated with two fatal infections, both herpesvirus.  This new treatment is not a panacea, and it may well turn out to be the new Tysabri, another highly-anticipated MS drug that led to progressive multifocal leukoencephalopathy. (I had a patient with that, too. It was ugly.)

But for now, at least, a very tentative thumbs-up to Novartis.

(Disclaimer: I don’t work for Novartis, and I don’t think I own their stock, but I’m not a medical professional yet either. This is not intended to be medical advice. Please don’t go to your neurologist and demand fingolimod; or if you do, at least have a better citation than “some med student blog on the internet.”)

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