http://www.nationalpost.com/todays-paper/relief+horizon/3903306/story.html

MS relief on the horizon
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.National Post . Tuesday, Nov. 30, 2010
The 55,000 to 75,000 Canadians with multiple sclerosis may find new relief
from the injections they depend on. 
Health Canada is expected to approve a new medication in pill form in 2011,
says Dr. Paul O'Connor, director of the MS clinic at Toronto's St. Michael's
Hospital. The drug has been approved for use in the United States. "Phase
three clinical tests have shown it is more effective than the existing
interferon-based medications, which we have used safely for up to 15 years,"
he says. 
That new pill may be just the start, Dr. O'Connor says. New MS research
means there are five different pill-form medications either in or through
phase three clinical tests plus other medications in the pipeline, including
a trio of new injectables, which are perhaps three years away. "All hold the
promise of greatly improved treatment options," he says. 
Physicians have six approved therapies to choose from to alleviate the
suffering and slow the progress of the disease. Five are injectable,
interferon-based medications; the other is a once-monthly infusion. While it
has, to date, prevented recurrence of attacks for up to two years, it does
have a serious downside, Dr. O'Connor says. 
It has been associated with a rare condition known as PML (progressive
multifocal leukoencephalopathy), an opportunistic viral infection of the
brain that can lead to death or severe disability. The risk of PML appears
to increase the longer a patient receives the infusion treatment, especially
after receiving treatment for more than 24 months. Since the disease is
progressive the goal of medication to date is not to cure but to prevent or
reduce the frequency of those attacks. 
Dr. O'Connor notes, however, the interferon-based medications -- which rely
on self-injection up to once a day -- come with side effects and may be hard
for patients to administer. "Trials on the new pill form, which also relies
on antibodies, show it does not have those side effects such as flu-like
symptoms or skin infections and rashes near injection sites," he says. 
"In head-to-head trials it was also shown to be more effective in preventing
attacks than the interferon-based medications." The efficacy of the new
pills has not been compared in clinical trials with the existing
once-monthly infusion treatment, which is usually reserved for patients with
more severe MS. 
Dr. O'Connor says he has trialed three of the five new pill-form medications
in his clinic and each showed improved efficacy. Equally important, they
helped restore an almost normal quality of life to patients. 
"Restoring quality of life is crucial to the success of medications. And
these new pills seem to do that." 
Dr. O'Connor says that in the United States the yearly cost of the pill
therapy is about $46,000 and given past experience, while third-party
medical plans may be willing to pay, provincial drug formularies are
unlikely to approve coverage. 
By comparison, the older injectables cost about $20,000 a year and are
covered in provincial drug benefit plans. The newest of the existing
approved treatments, the infusion-based medication, has an annual cost of
about $36,000-plus. It is currently covered in New Brunswick, Quebec,
Ontario, Manitoba, Saskatchewan, Alberta and British Columbia. 
"Cost is a concern with many new medications," he says. "The benefits may be
substantial but cost of treatment continues to limit widespread use." 
Visit nationalpost.com/chroniccare

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