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Improving established MS therapies

Read time: 60 mins
Last updated:9th Jul 2021
Published:9th Jul 2021

How can long-term understanding of established therapies for multiple sclerosis (MS) be harnessed to improve the patient experience? Watch clips from this virtual satellite symposium to:

  • Learn about the tolerability and possibilities with intramuscular administration of peginterferon beta-1a
  • Discover new research showing how a different fumarate chemical structure can affect gastrointestinal (GI) tolerability and work productivity while maintaining bioequivalent levels of the circulating active compound monomethyl fumarate (MMF)
  • Explore how subcutaneous (SC) administration of natalizumab can reduce the burden of treatment for patients and the healthcare system, a topic of particular relevance during the pandemic
  • Keep up to date with how long-term safety data is changing the use of established MS therapies
  • Consider new data and guidelines for MS therapies as they relate to COVID-19

In this virtual satellite symposium, Professors Til Menge, Anne-Katrin Pröbstel and Bart Van Wijmeersch discuss the latest updates to MS treatments, with a focus on individualising MS care to achieve clinically meaningful outcomes and improve patient experiences. These presentations will present data illustrating that:

  • Intramuscular administration of peginterferon beta-1a provides an option for reduced injection-site reactions in the interferon format that is the least frequently administered
  • Diroximel fumarate* results in fewer GI side effects that impact quality of life than observed with dimethyl fumarate
  • Subcutaneous administration of natalizumab is a high efficacy treatment option with improved convenience and flexibility vs intravenous administration

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How can long-term experiences with multiple sclerosis (MS) therapies facilitate advancements to further individualise MS care? What are the possibilities with intramuscular administration of peginterferon beta-1a? In the following five videos, Professor Til Menge discusses how long-term experience with established MS therapies has led to significant improvements in patient outcomes and experience. Before handing over to his co-faculty members, he explores the new data leading to the approval of intramuscular peginterferon beta-1a.

What can we learn from long-term experience with established therapies?


Advancements in the understanding of MS pathology has led to improvements in the treatment of MS. Long-term real world data has now demonstrated that, for patients with highly active disease, timely escalation to a high-efficacy therapy significantly reduces disability progression. As the number of disease-modifying therapies continues to grow and their safety is tracked, those with longer term clinical use provide the greatest knowledge for improving MS treatment.

How long-term data informs decision-making

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Can a next-generation fumarate advance clinically meaningful outcomes for MS patients? In the following four videos, Assistant Professor Anne-Katrin Pröbstel explores the similarities and differences between dimethyl fumarate (DMF) and diroximel fumarate (DRF*). The distinct chemical structure of DRF is hypothesised to improve gastrointestinal (GI) tolerability compared to DMF, leading to fewer interruptions to patients’ daily lives.

Fumarates: Milestones and opportunities for improvement


Experience in over 500,000 patients has led to guidance that facilitates the tailoring of dimethyl fumarate (DMF) to maximise safety according to individual patient trajectory. While DMF has demonstrated a robust efficacy and safety profile, GI side effects, which arise commonly during the first month of treatment, can lead to discontinuation of the drug. The proportion of patients discontinuing DMF therapy due to GI-related adverse events in the two-year Phase 3 studies was 4%, but 8–14% of patients have been reported to discontinue DMF in the real world. This has led to the investigation of whether alternative fumarate molecules with improved GI tolerability could improve patient quality of life.

Dimethyl fumarate and diroximel fumarate: What are the similarities and differences?

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Can a subcutaneous (SC) route of administration of natalizumab enhance flexibility and convenience for patients? In the three videos below, Professor Bart Van Wijmeersch discusses milestones in the 15 years of clinical experience with intravenous natalizumab, recently published data on natalizumab SC and the implications for its availability to patients and clinics.

Natalizumab: Historical milestones and treatment outcomes


There are now 15 years of clinical experience with natalizumab. Over the years, natalizumab has demonstrated long-term efficacy, and increasingly useful solutions have been identified to mitigate the risk of progressive multifocal leukoencephalopathy (PML). A high proportion of patients report “feel good” outcomes on natalizumab, experiencing improvements in their overall well-being, physical function and quality of life. One way to improve this therapy for patients would be the possibility of SC administration. The EMA recently approved Q4W dosing of 300 mg natalizumab SC and the key data for this will be described in the next section.

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What other aspects should be considered regarding the advancements to peginterferon beta-1a, fumarate*, and natalizumab options? In the nine videos below, the expert faculty ask each other to highlight the latest data or guidance that would help them better address the types of decisions they need to make for the individual situations of their different patients.

What are the considerations for MS treatment and COVID-19 infection and vaccination?


A particularly relevant question surrounding multiple sclerosis (MS) treatments today is the impact they could have on COVID-19 infection and vaccination. Regarding interferon beta treatments, current data indicates that they do not increase COVID-19 susceptibility compared to other disease-modifying therapies (DMTs), and their use in MS patients may be protective against severe disease. The evidence-based MS International Federation guidelines for COVID-19 vaccination do not require any adjustments to the timing of treatment initiation or dosing for interferons, glatiramer acetate, teriflunomide, dimethyl fumarate (DMF) or natalizumab.

Are there any special considerations regarding vaccination of natalizumab-treated patients?


Does natalizumab treatment impact response to vaccination? Previous studies with neoantigen and recall antigen illustrate that MS patients on natalizumab therapy experience comparable immune responses to vaccines versus those without natalizumab treatment. As the opportunity to vaccinate may occur at the same time as natalizumab dosing, this study shows that immunisations can even take place on the same day as natalizumab treatment.

What are the practicalities for initiating and/or switching patients to natalizumab SC?

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Now you’ve watched the highlights of the ‘Advancing MS Therapy: 

Addressing the Patient Experience’ symposium, why not test your knowledge on intramuscular peginterferon beta-1a, diroximel fumarate, and subcutaneous natalizumab.

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