Well the answer is simple….If we look at the effect of Laquinimod
on the relapse rate, then both ProfG and MD would agree that the influence of laquinimod is rather poor compared to other DMT on relapse rates.
This is in response to the trial data
Comi G, Jeffery D, Kappos L, Montalban X, Boyko A, Rocca MA, Filippi M; ALLEGRO Study Group. Placebo-controlled trial of oral laquinimod for multiple sclerosis.N Engl J Med. 2012;366:1000-9
Vollmer TL, Sorensen PS, Selmaj K, Zipp F, Havrdova E, Cohen JA, Sasson N, Gilgun-Sherki Y, Arnold DL; BRAVO Study Group.A randomized placebo-controlled phase III trial of oral laquinimod for multiple sclerosis. J Neurol. 2014 ;261:773-83.
In both cases the reduction of relapse rate was very modest and in support of the dim view expressed by MD, both the European and US regulator did not approve laquinimod apparently on a risk:benefit exercise.
Pharma are probably responding to the whims of the regulators, so they (FDA) are in part culpable. NICE complain about the costs, but in responding to regulators, pharma is having to spend millions of dollars in the drug develop process and Society bears the extra cost passed on.
However ProfG was excited because of the apparent impact of laquinimod on the rate of brain atrophy, which suggests that it may neuroprotective capacity and slow brain shrinkage. This will be identified in CONCERTO
MD thinks this prospect would be exciting too.
ProfG said ” I am very impressed by the laquinimod phase 3 results. Why? Despite its weak anti-inflammatory effects laquinimod has an impact on disability progression, that appears to be independent of relapses and it slows the rate of brain atrophy. All this points to laquinimod having neuroprotective effects downstream of inflammation”.
Then the question will arrive will you and take a drug and importantly will your neuro prescribe a drug that is beneficial in terms of slowing disability, but at the same time it is not stopping you from relapsing. Is the effect on disability better than could be
achieved by other DMT that are more effective at stopping relapses. However based on the published data it looks like a neuroprotective drug. In the beasties we have a lot of these now that don’t inhibit relapse but do slow the accumulation of disability.
So will Laquinimod be beneficial for progressive MS.We shall see as there are currently trials in progressive MS (NCT02284568) and hope it works
So on its own Laquinimod may not be great at controlling relapses in MS, but it may have value in slowing the rate of progression in both relapsing MS (especially if combined with a DMT that inhibits relapsing disease) and progressive MS.