April 25, 2013 -- With the arrival of Tecfidera this spring, people with multiple sclerosis now have three oral drugs to choose from to treat the relapsing form of the disease.
Tecfidera (dimethyl fumarate) joins two other oral MS drugs. Aubagio (teriflunomide) was approved in 2012, and Gilenya (fingolimod) was approved in 2010.
For the 350,000 people in the U.S. who have MS, these drugs represent a treatment breakthrough. Other MS drugs used to treat the relapsing form are injected or given through an IV.
All three oral MS drugs are expensive. Tecfidera's wholesale cost is nearly $55,000 a year. Gilenya and Aubagio cost $60,000 and $45,000 a year. The actual cost to a patient will depend on what type of insurance coverage they have.
With these three oral drugs, what do patients need to know about benefits and side effects?
For answers, WebMD turned to Barbara Giesser, MD, professor of neurology and clinical director of the University of California Los Angeles Multiple Sclerosis Program. She was not involved in the clinical trials for any of the three drugs.
Giesser: It appears to have anti-inflammatory actions and brain-protective actions. The main problem in MS is that immune cells are getting into the brain and the spinal cord and they are attacking the nerves. One of the main ways they cause damage is by inflammation, particularly in relapsing-remitting MS.
So Tecfidera does a number of different things to lower inflammation and lower the ability of the immune cells to get in and attack the central nervous system. Additionally, it may protect nerves from damage.
How do Gilenya and Aubagio work?
Giesser: Gilenya prevents the T-cells, the immune cells, from getting out of the lymph nodes. I tell my patients it's like the "roach motel" model of immunity. They can check in, but they can't check out.
The T-cells can't get out of lymph nodes and into the blood. If they can't get into the blood, they can't get into the nervous system.
Gilenya also may protect the brain.
Aubagio basically decreases production of T-cells and B-cells, which are also immune system cells.