Which oral?

I am often asked which oral would you prescribe? There is no simple answer to this question. The answer will depend on several factors some of which are still to emerge; to mention a few:

1. If and when these agents get licensed and the conditions of licensing; i.e. a first- or second-line indication.
2. The price and more importantly the cost-effectiveness of the agents; NICE will dictate the conditions of use in the UK.
3. Level of disease activity; inactive vs. active vs. highly-active disease.
4. Perceived long-term risk; infections and possible risk of malignancy.
5. Local infrastructure to start the orals.
6. Requirements and intensity of monitoring whilst on medication.
7. Fertility issues.
8. Previous use of other disease-modifying agents.
9. Underlying medical problems.
10. Etc, etc.

It is clear from the above that the decisions about which agent to use will be personalised and will depend largely on patient choice. It is important to ensure that patients have choice and that the choice is an informed one.

Prof G

One thought on “Which oral?”

  1. Patient choice is one of those annoying terms which when tested offers little. A patient wants rid of this disease or at least to put it into long term remission. The current injectibles offer c.30% reducion in relapse rate, so the only choice is the number of injections per week. Tysabri is not a choice for those who (i) do not have highly active disease or (ii) do not want PML. The oral treatments offer more choice in terms of treatments, but not in terms of stopping / reversing the disease (which all patients would choose). Of course for those with SP or PP there is no choice in terms of treatments (the only positive being no side effects!).

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