Personalized medicine in the focus of treatment management

Do we need more therapies? This question is being asked more and more frequently at congresses. The reason for this is the large number of new approvals in recent years. The answer is simple: yes. Because the more specific the drugs are and the more different the dosage forms are, the more individualized the selection can be. Personalized medicine is therefore no longer just a dream of the future in the management of MS.

More and more people are suffering from the most common inflammatory neurological autoimmune disease, multiple sclerosis (MS). Estimates put the number of people affected in Switzerland in 2021 at 18,000 – an increase of 20% compared to a projection in 2016 [1]. More recent data is not available for Switzerland. The gender ratio is 2.7 women for every 1 man and the strongest increase among all those affected is seen in women under 60 [1]. Those affected most frequently suffer from a form of MS with a relapsing-remitting course (relapsing-remitting multiple sclerosis, RRMS). As the name suggests, it progresses in episodes with acute symptoms lasting at least 24 hours. The intensity, timing of the episodes, duration and type of symptoms vary greatly from person to person. The disease-related restrictions can disappear completely after the end of the episode, but can also have a lasting effect or lead to a permanent disability or a worsening of the existing disability.

The right therapy for every need?

MS, also known as the disease of a thousand faces, manifests itself clinically differently in each patient. Symptoms such as motor disorders, visual disturbances, pain or incontinence, fatigue, depression and cognitive impairment can occur. Depending on the varied course and specific symptoms, treatment management should be adapted to individual needs. In addition to short-term relapse therapy, which addresses the containment of the relapse, a course-modifying treatment aims to reduce the severity and frequency of the relapses. The aim is to positively influence the progression of the disability. One focus in RRMS is on immunomodulators, some of which have been used as basic therapy since the end of the last century. These include beta interferons or glatiramer acetate [2]. Over time, these have been supplemented by the active substances cladribine, dimethyl fumarate, ozanimod, ponesimod, teriflunomide, fingolimod and the monoclonal antibodies alemtuzumab, natalizumab, ocrelizumab and ofatumumab.

Fumaric acid is an organic chemical substance whose ester is used in the treatment of MS. Dimethyl fumarate has an anti-inflammatory effect. In addition, neuroprotective and myelin-protective properties are discussed [3,4]. In an oral formulation as diroxime fumarate, a comparable effect with an improved side effect profile has been demonstrated [3,4]. Both drugs are converted in the body into the active form, monomethyl fumarate. The antibody natalizumab has also been used for years in escalation therapy. This first monoclonal antibody prevents immune cells from migrating through the blood vessels into the brain, thereby suppressing inflammatory activity. Since 2021, it can also be applied subcutaneously and no longer has to be administered as an infusion every four weeks. The two formulations do not differ from each other in terms of their relevant pharmacological criteria [3,4].

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