Microsoft word - in a nutshell october 2013-oral comparisons.doc

COMPARING THE THREE ORAL MEDICATIONS
Aubagio® (teriflunomide), a pyrimidine synthesis inhibitor, is an oral compound that inhibits the function of specific immune cells that have been implicated in MS. It is related to leflunomide, a drug used to treat rheumatoid arthritis. Aubagio can inhibit a key enzyme required by white blood cells (lymphocytes) – which in turn reduces the proliferation of T and B immune cells that are active in MS and also inhibits the production of immune messenger chemicals by T cells. Gilenya™ is a new class of medication called a sphingosine 1-phosphate receptor modulator, which is thought to act by retaining certain white blood cells (lymphocytes) in the lymph nodes, thereby preventing those cells from crossing the blood-brain barrier into the central nervous system (CNS). Preventing the entry of these cells into the CNS reduces inflammatory damage to nerve cells. Tecfidera™ is an oral therapy contained in capsules taken two times per day. Tecfidera, formerly known as BG-12, is dimethyl fumarate, a formulation that was developed specifically for use by people with multiple sclerosis. A chemically related compound, called Fumaderm (dimethyl fumarate and fumaric acid esters), has been used at higher doses for decades in Germany to treat acute flare-ups of psoriasis. Although its exact mechanism of action is not known, Tecfidera is thought to inhibit immune cells and molecules, and may have anti-oxidant properties that could be protective against damage to the brain and spinal cord Warnings and Precautions Aubagio-The prescribing information contains a boxed warning about the potential for liver damage (hepatotoxicity). Severe liver injury, including fatal liver failure has been reported in patients taking leflunomide to treat rheumatoid arthritis, and a similar risk would be expected with Aubagio (teriflunomide) because of the similarities between the two medications. Gilenya- may cause your heart rate to slow down, particularly right after the first dose, with the drop being most significant at about six hours after the dose is taken. Gilenya lowers the number of lymphocytes in the blood causing risk of infection. Gilenya can cause a swelling of the macula. Macular swelling can cause symptoms similar to those that occur with an attack of optic neuritis. Gilenya may cause liver problems and shortness of Tecfidera reduced blood lymphocyte (white blood cell) counts but no significant or severe infections were reported. Liver enzyme tests were elevated, but there were no reports of significant liver injury or liver failure. Aubagio-The most common side effects in the clinical trials were diarrhea, abnormal liver tests, nausea, influenza, and hair thinning (alopecia Gilenya-The most common side effects in the clinical trials were headache, influenza, diarrhea, back pain, abnormal liver tests, and cough Tedfidera-The most common side effects in the clinical trials were flushing (which can create a sensation of heat or itching and a red blush on the skin) and gastrointestinal events (such as diarrhea, nausea, and upper abdominal pain) Tecfidera reduced blood lymphocyte (white blood cell) counts but no significant or severe infections were reported. Source: http://www.nationalmssociety.org/about-multiple-sclerosis/what- Just For Fun Put these FDA approved disease modifying therapies in order of their approval to the general public for treatment of MS. Tecfidera Tysabri Extra credit if you get the year correct. Extra, Extra credit if you get the http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuse

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