Another one that was just approved has risks for immune suppression. Laquinimod does not appear to have a risk for immune suppression, yet it has efficacy in relapsing-remitting MS.
Many patients who will tolerate one drug will not tolerate another drug, so it will be very easy to find a niche for this particular drug.
Most patients don't want an injectable therapy. On the other hand, we have to recognize that even an oral medication can pose some risks. Laquinimod does not seem to have any of those risks, but it causes immune modulation, so it may fit in early MS where it may show its greater efficacy.
What we've learned in the last 10 years – and most important of all – is not which drug to use, but when to treat, and to treat early, because treating early seems to be where we can see the best and most effect.
Laquinimod has a different mechanism of action. It seems to involve the signaling pathways that are in the innate immune system. We're learning about that now. There is going to be much more to be learned about this drug after it's approved in terms of its mechanisms of action.
SCOTT S. ZAMVIL, M.D., is professor of neurology at the University of California, San Francisco. He was not associated with the laquinimod study. He has been a consultant for Teva Pharmaceuticals, Biogen Idec, and Serono. In addition, Dr. Zamvil has received grant support or served on data safety monitoring boards for multiple drug companies.