OK, we have discussed the available and the soon to be available oral medications for MS. The next obvious question is who should consider switching or beginning oral medications, and when.

There are several types of patients for whom I would consider an early switch.

1) patients experiencing frequent or serious relapses while taking the first line injectable drugs (Copaxone, Betaseron, Rebif, Avonex), especially if they have risk factors for PML with Tysabri.

2) patients having significant side effects, including injection site reactions, from these drugs. This includes the “needle-phobic” patients.  

3) Tysabri patients who become allergic or develop neutralizing antibodies, or who have risk factors for PML.

Other patients who may be good candidates for oral meds include newly diagnosed patients, especially relapsing remitting patients. 

Patients doing well on whatever therapy they are currently may be smart to continue as they are doing for now.  While the medications expected next year appear to be safe so far, we know that serious side effects sometimes do not appear until a drug has been in more widespread use for a longer time.

Patients with progressive MS, either primary or secondary, will of course be interested in these medications, but we just don’t have any information yet as to whether or not they will help in that situation. 

There may not be any absolute right or wrong answers to some of these questions until a little more time goes by, but it is at least exciting to have more options to look forward to.

Next:  Tysabri update — safety data, risk assessment