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


November 12, 2013

In This Article

Sequencing the Available Drugs

Dr. Freedman: Let's think about the drugs that we do have. The injectable natalizumab has been on the market for a little while. In come these new oral agents, perhaps with some different mechanisms, and then the powerhouse alemtuzumab. Do we have to consider the order in which we use them, or if you gave an induction therapy with alemtuzumab and the patient stabilizes for a couple of years, would you want to use natalizumab after that?

Dr. Coyle: There is concern about staging. One of the risk-stratification factors for progressive multifocal leukoencephalopathy with natalizumab is previous immunosuppressive therapy. Alemtuzumab would count as immunosuppressive therapy. So if you use alemtuzumab before natalizumab, you have put patients who are JC virus-infected at higher risk.

Dr. Freedman: We are excited about new therapies. We are not certain where they are going to be positioned, and we are not sure yet, as we start to use them, what risks will evolve, but it is always nice to expand the tool chest. That is what is so exciting about coming to ECTRIMS and learning about all of these wonderful new treatments. Thank you very much for your attention.


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