Should I go on Gilenya?

Question:
I recently just went back to my doctor. He is wanting to take me off of Copaxone. I have been on this medicine for almost a year but my doctor does not think it is working. I was told I had MS in January of 2016. I started Copaxone in May and have been on it since. However, in February I had two relapses and a new MRI that showed more lesions. My doctor want me to now try Gilenya but I am nervous about this because of all of the side effects. I have had optic neuritis and that is one of the side effects of Gilenya. Do you think there is a better option?

Answer:
If I understand you correctly, you were diagnosed with MS in January 2016, started copaxone in May 2016 and experienced 2 relapses and MRI activity in February 2017 while taking copaxone

First, If these facts are correct, I agree with your doctor that the copaxone is not working. You’ve been on it for over 6 months with both clinical and MRI evidence of continued disease activity.

Second, you have many options at present; Gilenya may be a good option for you. GILENYA DOES NOT CAUSE OPTIC NEURITIS. A small number of people experience macular edema, which is entirely different and unrelated to optic neuritis. This is why we monitor people on Gilenya for the first 6 months of treatment with every 3 month Optical Coherence Tomography. This is a very simple test that only requires bouncing a harmless light source off your retina.

Third, Gilenya is very well tolerated by most patients. In fact this is one of the benefits of this drug. Like all disease modifying therapies there are some potential risks (e.g. a slight increased risk of Shingles or transient heart block) but we mitigate these risks through our pretesting and monitoring protocol

There may be many other DMT options for you to consider at this time as well, depending on your disease characteristics and risks of disease worsening. For instance both tecfidera and aubagio are good oral options as well. Your current MS specialist is in a better position to recommend the most appropriate of these 3 oral drug options

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego