Side effects of disease modifying treatment of multiple sclerosis
Keywords:
pregnancy, multiple sclerosis, side effects, treatmentAbstract
Multiple sclerosis is an autoimmune disease that causes disability in young persons. The modern medicine has more than 20 years of experience with disease modifying drugs. Currently more than 12 drugs with different mechanism of action and side effects are used. The first approved drugs – beta-interferons (IFN ß-1b и ß-1a) have fewer side effects, mainly skin reactions and flu-like symptoms. Glatiramer acetate is also one of the first used drugs and the side effects are mainly skin reactions. The drug may be used during pregnancy and breastfeeding.
The monoclonal antibodies natalizumab, alemtuzumab and ocrelizumab have adverse reactions connected with the infusions, autoimmune complications, infections and in some cases progressive multifocal leukoencephalopathy. The risk for malignancy is increased. The drugs are not used during pregnancy and breastfeeding.
The oral drugs fingolimod, teriflunomide, dimethylfumarate and cladribine have different mechanism of action, but may cause infections and malignancies. The drugs are not used during pregnancy and breastfeeding.
In conclusion the therapeutic options for multiple sclerosis patients have been progressively increasing during the last years. It is important that the most propriate drug for any particular patient is find, having in mind the side effects also. The side effects of ß interferons and glatiramer acetate are well known, but the risks connected with the newer drugs are not entirely clear. However, some of the new drugs are more effective that the old ones, that faces a dilemma for the treating physician.
Patients with lower drug activity is probably better to be treated at the onset of the disease with drugs with lower serious side effects. After activation of the disease the treatment may be changed to drugs with more potential side effects. The willing for pregnancy and having a child is important for the young women, and should be have in mind. In this moment there is only one drug (glatiramer acetate) that may be used during pregnancy.
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