Saturday, September 26, 2009

More Drugs

Cladribine is a drug used to treat hairy cell leukemia. For treatment of cancer it is given by IV, but for MS, it is given orally. It is currently awaiting approval for use in MS. It is long lasting, but side effects include a reduction in white blood cells and infections like shingles. There are also some questions about cancer developing as a result of using the drug.

Fingolimod is currently in phase 3 of clinical trials and is also showing promising results. It, too, is an oral medication, but its side effects include risk of infections, heart rate and blood pressure increases, and lung and skin cancers.

Dimethyl fumarate, which I'm sure will get a sexier name at some point, has been used to treat psoriasis. It has also been used as a mold inhibitor in consumer products, though now is being banned for that use. It is showing promise as a treatment for MS because of its neuro-protective properties and its ability to inhibit pro-inflammatory cytokines (cytokines are a type of chemical messenger - reduce the inflammatory cytokines and you potentially have a treatment for MS). This drug is an oral medication currently in Phase 3 trials. Side effects included abdominal pain, flushing. and headache.

Laquinimod is currently in Phase 3 trials and has immunomodulatory effects and may offer some neuroprotection. Like the interferons, liver enzymes must be watched closely, and the drug also shows promise for treating other autoimmune diseases. And it's an oral med.

Daclizumab is a drug commonly used as an anti rejection drug for transplant patients. It increases natural killer cells and is well tolerated. There is the possible increase in infections as a side effect and it is given in injection form once a month. It is currently in Phase 3 trials.

Rituximab has been used for treatment of leukemia as an antibody against B cells. It is given by IV every six months. Side effects include viral infections and reactivation of viral infections (in particular, the JC virus which leads to PML) and cardiac arrest. Needless to say, if you take this stuff, the docs will watch you like a hawk. In Phase 2 studies, completed last year this drug has shown promise.

Alemtuzumab is another cancer therapy with a profound effect on MS. The Phase 2 trials have been completed. Side effects include low platelets and thyroid problems, so again, the docs would keep a close eye on you if you're on this drug.

There are a great many more drugs and treatments in the pipeline, but the ones I've mentioned are the ones closest to consumer use.

All of the above drugs are currently being studied and are 1-5 years away from coming on the market for treatment of relapsing remitting MS. However, these drugs have pretty serious side effects. They all show promise and studies of these drugs and the DMDs all show that earlier treatment of MS is going to lengthen the time to disability. Ideally, someone will come up with a cure. Do it now, would ya'?


PS: Next up, I'll be telling you about some other treatments including the alternative ones.


Lisa Emrich said...

After such a difficult MS summer, I discussed Rituxan with my neurologist who thinks that it might be a good idea. The neuro infusion nurse thinks it's a great idea. Next up is talking to my rheumatologist about using it for my RA. We'll see how that discussion goes.

Also, I really came over to introduce you to Kmilyun's blog (if you don't know it already). Her post today would be of interest to you - Bugger Me.

Go check it out.

Shauna said...

Thanks for the tip....great site! And great pics of a bug!

And be careful on the Rituxan, if you decide to take it. And of course you'll keep us up to speed on how it's working. Right? Right. Good.


cleandrover said...

Thanks for summarizing everything from the information session on Tuesday, Shauna. I write slowly and as a result my notes are sparse and vague. And it was so nice to finally meet you!


Lisa Emrich said...

I just saw my rheumatologist yesterday and we discussed Rituxan. My RA is not extremely bad and she has only used Rituxan in very bad cases. So she wanted to talk to my neurologist about it first.

She called this morning and said - It's a go!! Dr. S. is excited for you to be on Rituxan. But he says that you have to be off Copaxone for 2 weeks first. (I thought that this would be on top of copaxone initially.)

Now I've just got to reach which hospital my insurance prefers among the hospitals where my rhematologist is associated.

The infusion takes place over 6 hours and they watch closely for immediate reactions. Then you go back for the 2nd infusion two weeks later. Then not another one until 6 months later.

I'm excited and suddenly a little nervous. This might actually help!! Time to go research copay assistance and insurance and such.