REVIEWER: Paul Giacomini, MD, FRCPC, Associate Director, Multiple Sclerosis Clinic, Montreal Neurological Hospital and Institute, Assistant Professor, Department of Neurology and Neurosurgery, McGill University, Canada

Switching studies
Effect on brain volume change
Updated safety data

The high-efficacy disease-modifying therapies (DMT; natalizumab, fingolimod, alemtuzumab) used to treat relapsing-remitting multiple sclerosis are often reserved for patients with severe disease at presentation or those with an inadequate response to other agents. However, these therapies are increasingly being employed earlier in the disease course. In part this is due to the growing recognition that first-generation injectable DMTs appear to have less impact on disability progression. In addition, there is increasing evidence that more potent suppression of inflammatory disease activity has the potential to reduce CNS tissue damage, slow the rate of brain volume loss and improve long-term physical and cognitive outcomes. However, the benefits of this more aggressive approach need to be weighed against the risk of adverse effects with higher efficacy agents. Read More

REVIEWER: Mark S. Freedman, HBSc, MSc, MD, CSPQ, FANA, FAAN, FRCPC, Professor of Medicine (Neurology), University of Ottawa, Canada

Efficacy
NNT analysis
Safety
Natalizumab discontinuation studies
NeuroSens Survey on first-line orals

The 2015 annual meeting of the American Academy of Neurology (AAN) provided new data on the initiation and optimization of disease-modifying therapy (DMT) for multiple sclerosis. Of particular interest was research on the most recent DMTs, teriflunomide and dimethyl fumarate (DMF), the two oral therapies indicated for first-line treatment. (In Canada, fingolimod is generally recommended as a second-line agent.) Phase III extension data have now been supplemented by real-world observational studies on the effectiveness of therapy in practice, including drug safety and tolerability. Read More