Mark S. Freedman, MD, MSc; Patricia K. Coyle, MD


November 12, 2013

In This Article

Injectables Become More Convenient

Dr. Freedman: What about the injectables? They haven't fallen off the side of the earth yet, but some developments are changing some of the injectables. What are those?

Dr. Coyle: A couple of interesting developments should make injectables easier to use. Glatiramer acetate, for example, has been studied in a double dose of 40 mg subcutaneously 3 times weekly instead of 20 mg daily; and with interferon beta, they now have a pegylated subcutaneous form that would be given every 2 weeks, so, much less dosing. We are waiting to see whether they are going to be approved. It is highly likely that we will have them in a year or so.

Dr. Freedman: Let's return to alemtuzumab, an exciting agent. Is it a first-line drug?

Dr. Coyle: This is a real issue. I view alemtuzumab as an induction strategy. The question is, would you use it in a treatment-naive patient? Certainly in the trials it was used with very good results, but I am a bit leery of doing that. It would be easier to justify for a patient who is clearly failing other treatments, and then you might move to it very quickly.

Dr. Freedman: It is very attractive to patients, given its annual administration schedule. Patients take it only once a year, and then they don't have to take anything for the full year. Why wouldn't you want to use that first-line? What's the downside?

Dr. Coyle: First,there is up to a 30% rate of thyroid disease, a small risk for immune-mediated thrombocytopenia which must be monitored and that might need to be treated, and a risk for immune-mediated renal disease, which can be severe although extremely rare. We don't have huge numbers of patients who have been treated multiple times with alemtuzumab to have a good sense of whether there might be some long-term problems associated with it.


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