Long-term treatment of relapsing-remitting multiple sclerosis with interferon β: how strongly should we encourage patients to adhere to the ‘old’ therapies?

Current recommendations and guidelines for use of disease modifying drugs (DMDs) in relapsing-remitting multiple sclerosis refer to interferon β (IFNβ) and glatiramer acetate as injectables as well as the new orals teriflunomide, dimethyl fumarate (DMF) and also fingolimod, natalizumab and alemtuzumab. Several pivotal studies have demonstrated a short-term benefit for earlier treatment with DMDs on clinical and MRI activity but there are only limited data available from controlled studies on long-term clinical outcome including sustained accumulation of disability and conversion to secondary progression. Therapeutic decision-making in clinical practice is at risk to be influenced by patients’ needs for high tolerability and convenience of DMDs. Recently, reports on unexpected side effects of the new orals including single case reports of progressive …