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Disease modifying therapy in relapsing-remitting MS

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Disease modifying therapy in relapsing-remitting multiple sclerosis has two aims:

  • reduction in the frequency and severity of attacks
  • prevention of the accumulated disability associated with transition to secondary progressive multiple sclerosis

Effective therapies are immune modulators and include:

  • interferon beta-1a
  • interferon beta-1b
  • glatiramer acetate
  • azathioprine

NICE

  • have recommended that natalizumab is an option for the treatment only of rapidly evolving severe relapsing - remitting multiple sclerosis (1)

  • interferon beta-1a is recommended as an option for treating multiple sclerosis (2), only if:
    • the person has relapsing-remitting multiple sclerosis and
    • the companies provide it according to commercial arrangements

  • interferon beta-1b (Extavia) is recommended as an option for treating multiple sclerosis (2), only if:
    • the person has relapsing-remitting multiple sclerosis and
    • has had 2 or more relapses within the last 2 years or
    • the person has secondary progressive multiple sclerosis with continuing relapses and
    • the company provides it according to the commercial arrangement

  • glatiramer acetate is recommended as an option for treating multiple sclerosis (2), only if:
    • the person has relapsing-remitting multiple sclerosis
    • and the company provides it according to the commercial arrangement

  • have recommended Fingolimod is recommended as an option for the treatment of highly active relapsing-remitting multiple sclerosis in adults (3)

  • have recommended Teriflunomide for treating adults with active relapsing-remitting multiple sclerosis (normally defined as 2 clinically significant relapses in the previous 2 years) (4)
    • only if they do not have highly active or rapidly evolving severe relapsing-remitting multiple sclerosis

  • have recommended Dimethyl fumarate as an option for treating adults with active relapsing-remitting multiple sclerosis (5) only if :
    • they do not have highly active or rapidly evolving severe relapsing-remitting multiple sclerosis and
    • the manufacturer provides dimethyl fumarate with the discount agreed in the patient access scheme

  • cladribine is recommended as an option for treating highly active multiple sclerosis in adults, only if the person has (7):
    • rapidly evolving severe relapsing - remitting multiple sclerosis, that is with at least:
      • 2 relapses in the previous year and
      • 1 T1 gadolinium-enhancing lesion at baseline MRI or a significant increase in T2-lesion load compared with a previous MRI, or
    • relapsing - remitting multiple sclerosis that has responded inadequately to treatment with disease-modifying therapy, defined as 1 relapse in the previous year and MRI
      evidence of disease activity

  • ofatumumab is recommended as an option for treating relapsing-remitting multiple sclerosis in adults with active disease defined by clinical or imaging features
    • is a human monoclonal antibody that binds selectively to CD20
    • although other currently available monoclonal antibody therapies for RMS are administered by intravenous infusion (e.g., alemtuzumab, natalizumab and ocrelizumab), ofatumumab is administered subcutaneously

Notes:

  • diemthyl fumaratederives from fumaric acid, promotes anti-inflammatory activity and can inhibit expression of pro-inflammatory cytokines and adhesion molecules
    • dimethyl fumarate has a UK marketing authorisation for 'the treatment of adult patients with relapsing-remitting multiple sclerosis'.

Reference:

  1. NICE (August 2007). Natalizumab for the treatment of adults with highly active relapsing-remitting multiple sclerosis.
  2. NICE (June 2018). Beta interferons and glatiramer acetate for treating multiple sclerosis
  3. NICE (April 2012). Fingolimod for the treatment of highly active relapsing-remitting multiple sclerosis
  4. NICE (January 2014). Teriflunomide for treating relapsing-remitting multiple sclerosis
  5. NICE (August 2014). Dimethyl fumarate for treating relapsing-remitting multiple sclerosis
  6. NICE (November 2019). Multiple sclerosis in adults: management
  7. NICE (December 2019). Cladribine for treating relapsing - remitting multiple sclerosis
  8. NICE (May 2021). Ofatumumab for treating relapsing multiple sclerosis

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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