- Diseases, Disorders & Conditions
The MS (Multiple Sclerosis) Pill
If you have MS, you may already know about the new treatment options available to you. If you are curious to know more about them, like I was, this article is for you. I have had multiple sclerosis since 2007 and am always looking for ways to improve treatment and symptoms. When the oral options became available, I was immediately intrigued. I have done a lot of research and feel the need to share what I have learned so it can be easier for other people to find. In this article, I want to go over the details of each MS pill currently on the market: fingolimod (AKA Gilenya), teriflunomide (AKA Aubagio), and dimethyl fumarate (AKA Tecfidera). I'll give you dosage information, side effects and the costs of these medications as well as important clinical research results.
Gilenya, the first oral medication that became available, is believed to reduce inflammatory damage to nerve cells by blocking white blood cells from crossing the blood-brain barrier and going to the central nervous system. It is prescribed to individuals with relapsing-remitting MS and in a two year study, it reduced relapses by 54% and also reduced brain lesion activity (measured by MRI). It also reduced the risk of disability progression by 30% at a dose of .5mg. In a one year study that compared Gilenya with Avonex, Gilenya reduced relapses by 52% compared with Avonex and reduced disease activity as measured by MRI. Gilenya was approved by the FDA in 2010.
Aubagio is related to leflunomide, which is used to treat rheumatoid arthritis. It inhibits the function of specific immune cells and can inhibit a key enzyme required by lymphocytes. In one phase 3 study over at least 108 weeks, Aubagio reduced relapses compared to placebo. Of two different doses, the higher dose also slowed progression of disability. Both doses (7mg and 14mg) slowed lesion development as measured by MRI compared to placebo. Aubagio was approved in the US in 2012 for people with relapsing forms of MS.
Tecfidera, from the creators of Avonex (Biogen Idec), has been used for decades in Germany for people with acute flare-ups of psoriasis. They don't know how it works, but it is thought to inhibit immune cells and molecules. It also may have anti-oxidant properties that could be protective against damage to the brain and spinal cord. Tecfidera was evaluated in two phase 3 clinical trials. In the two year study, there was a significant reduction in the number of people who had relapses at the two year mark compared with a placebo. For the twice-daily dose, 27% experienced relapses which is a 49% reduction in the risk of relapse. There was also, like Gilenya, a significant reduction in the amount of lesions as shown by MRI. In the second trial, disability progression was not reduced significantly in the Tecfidera groups, compared with the placebo group. This medicine was approved in 2013.
Side effects are an important part of choosing medication. All three of the MS pills have common side effects that many people will experience when taking the medication. For Gilenya, you need to take your first dose in the doctor's office so you can be monitored for six hours. This is because your heart rate will likely slow down. It will probably return to normal within one month of taking the medicine, but it is possible that it will last longer. More common side effects include headache, influenza, back pain, diarrhea, cough and abnormal liver tests. Shortness of breath is also possible.
Aubagio's side effects inlude diarrhea, abnormal liver tests, nausea, influenza and hair thinning. There seems to be a great emphasis on not taking this medicine if you are pregnant or plan to become pregnant or even if you are a man who wishes to father a child. There is also a potential for severe liver injury as well as numbness and/or pain the hands or feet. It can also cause transient acute renal failure (kidney failure) and high levels of potassium in the blood as well as severe skin reactions.
Tecfidera's side effects include flushing, diarrhea, nausea, and upper abdominal pain. If you take it with food, the flushing will be less likely. Both medicines create a higher risk of infection due to the medicines lowering white blood cell counts, but no severe infections were reported.
Have you discussed switching to one of the MS pills with your doctor?
Gilenya is a once-daily capsule of 0.5mg. There is no additional benefit to taking more than 0.5mg. You can take it with or without food. Your doctor needs to give you a blood test, eye evaluation, and an electrocardiogram for those with cardiac risk factors. You shouldn't take Gilenya if you are pregnant or nursing.
Aubagio has two doses: 7mg or 14mg. It is taken once per day with or without food. Your doctor should issue a blood test, blood pressure check, screening test for tuberculosis and a pregnancy test. After you begin treatment, you should have a monthly blood test for the first six months, monitoring for signs of infection, periodic monitoring of blood pressure as well as monitoring of kidney function and potassium levels. Do not take Aubagio if you are pregnant, plan to become pregnant, are nursing or are a male who wishes to father a child!
Tecfidera is taken twice per day. When you first begin treatment, you will be given a one-week reduced starter dose of 120mg twice a day, and after that you get a maintenance dose of 240mg twice a day. You can take it with or without food, but it is recommended to take Tecfidera with food to reduce the risk of flushing. Your doctor should check your white blood cell count before taking it. It is not known if Tecfidera will harm your unborn baby or if it passes into your breast milk, so do not take this medicine if you are pregnant or nursing.
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It seems that the oral medications on the market for multiple sclerosis are effective in reducing relapse rate as well as lesion activity. Gilenya, Aubagio, and Tecfidera should all be considered if you are new to MS and going over treatment options.
On a more personal note, I have tried to get my doctor to switch me from Avonex (actually two doctors) to a pill, but they would not due to the length of time they have been on the market. I plan to get switched in the next couple of years, and if I do, it will most likely be to Tecfidera. Gilenya came out first and I still worry about the deaths that occurred even though it's now known that those people had heart conditions and were on other medications. Aubagio sounds way more serious-meaning the side effects sound like some pretty serious side effects! Kidney failure? No thank you! I don't care if it's rare or not, they still had to put it in the information. Tecfidera just seems like the better choice in my opinion. If you disagree or would like to put in your two cents, please do so below!