Long-term Immunological Impact of Drug-Modifying Therapies in Multiple Sclerosis

EP: 1.S1P Receptor Modulators and the Treatment Landscape of Relapsing-Remitting Multiple Sclerosis

EP: 2.Tissue Selectivity of S1P Receptor Modulator

EP: 3.Safety Profile of S1P Receptor Modulators for Multiple Sclerosis

EP: 4.Monitoring Patients With Relapsing-Remitting Multiple Sclerosis on S1P Receptor Modulator

EP: 5.Switching Patients With Multiple Sclerosis to S1P Receptor Modulator

EP: 6.The Safety Data of Ozanimod in Multiple Sclerosis

EP: 7.The Safety of Other S1P Receptor Modulators in Multiple Sclerosis

EP: 8.Clinical Pearls for Treating Relapsing-Remitting Multiple Sclerosis With S1P Receptor Modulators

EP: 9.S1P Receptor Modulators in Multiple Sclerosis

EP: 10.Selecting S1P Receptor Modulators in Multiple Sclerosis

EP: 11.Long-term Data With Ozanimod in Relapsing-Remitting Multiple Sclerosis

EP: 12.Long-Term Data With Other S1P Receptor Modulators in Multiple Sclerosis

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EP: 13.Long-term Immunological Impact of Drug-Modifying Therapies in Multiple Sclerosis

EP: 14.Expert Advice on Multiple Sclerosis Treatment Cessation and Disease Rebound

EP: 15.Emerging Disease-Modifying Therapy Data in Multiple Sclerosis

EP: 16.Final Thoughts on S1P Receptor Modulators in Multiple Sclerosis

Transcript

Bruce Cree, MD, PhD, MAS: One of the things that the patients want to know about is whether medications they’re taking are suppressing their immune system, and what will be the long-term consequences from use of their MS disease-modifying therapies. It is not surprising that this is a considerable concern for our patients who have a chronic illness that requires long-term treatment. So it’s very important to understand this across the board, regardless of the disease-modifying therapy that any individual is using. The S1P [sphingosine-1-phosphate] receptor modulators, as a class, have excellent data supporting their long-term safe use in multiple sclerosis. Although these medications can have immune-suppressive effects, as proven by the rare occurrence of opportunistic infections associated with these medications—especially the most serious one, progressive multifocal leukoencephalopathy, or PML—in general, the vast majority of patients are not profoundly immune-suppressed from taking these medications. Several studies have looked at the effect of these medications on lymphocyte subsets and on other cells of the immune system, and, of course, not surprisingly, since these medications cause sequestration of lymphocytes within the lymph nodes and spleen, you see a decrease in cells in the circulation of several different lymphocyte subsets in circulation, and that is to be expected as part of the mechanism of action of all of these products. We also see some effects in terms of monocytes and neutrophils as well, which is unexpected because these cells don’t have S1P receptors on them, so it must have to do with networks within the immune system and crosstalk between the adaptive immune system and the innate immune system. Those details remain to be worked out.

Transcript edited for clarity.