A new oral treatment for multiple sclerosis?

Katherine Law, University College London Medical School, Gower Street, London WC1E 6BT

Multiple sclerosis (MS) is a debilitating disease of the central nervous system (CNS) due to demyelination of the brain and spinal cord. It manifests as a multitude of symptoms including optic neuritis, sensory deficits and motor weakness. Most cases of MS present with a relapsing-remitting course and patients often deteriorate in health and bodily functions as their disease progresses. Current treatment of MS includes parenteral agents such as beta-interferon and glatiramer acetate.

A recent study has looked at the efficacy of BG-12 (dimethyl fumarate), which is developed as an oral treatment for relapsing-remitting MS. In the phase 3 randomised controlled trial, patients are divided into three groups, taking 240mg of BG-12 twice a day, 240mg of BG-12 thrice a day and placebo respectively over a course of 2 years. The primary end point was the proportion of patients who had a relapse by 2 years [1].

The study shows that compared to placebo, both regimens of twice-daily BG-12 and thrice-daily BG-12 significantly reduced the proportion of patients who had a relapse (27% with BG-12 twice daily and 26% with BG-12 thrice daily vs. 46% with placebo). BG-12 is also shown to reduce the number of gadolinium-enhancing lesions in the CNS, and the rate of disability progression.

The study implies that patients with multiple sclerosis could use oral rather than parenteral treatment to control their disease. This may prove to be more convenient and boost compliance, although the long-term benefit and side-effects of BG-12 remain to be investigated.

References: 

1. Gold, R., Kappos, L., Arnold, D.L., Bar-Or, A., Giovannoni, G., Selmaj, K., Tornatore, C., Sweetser, M.T., Yang, M., Sheikh, S.I., Dawson, K.T., 2012. Placebo-controlled phase 3 study of oral BG-12 for relapsing multiple sclerosis. N. Engl. J. Med. 367, 1098–1107. DOI: 10.1056/NEJMoa111428

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