ProfG has created an off-label list of DMT. Many of them are based on the generic version of current MS drug, or a generic pro-drug of an active MS drug.
You perhaps would thought that Charities would want options for all people with MS, including those in resource-poor environments to have options. These studies could have been done by now, but my experience with generic cladribine told me otherwise. I don’t buy the idea that generics are second best and it is now only a matter of time before chemical generics arrive. Will we get change then? I have my predictions. However I get chastised for making these.
If you go to the effort of a buyers club, it is important that you don’t put duds into the mix.
ProfG asked about methotrexate?
Methotrexate was made in 1947 and initially came into medical use to treat cancer, as it was less toxic than the then-current treatments. Methotrexate is available as a generic medication. The wholesale cost as of 2014 in the developing world is between US$0.06 and US$0.36 per day for the form taken by mouth. It is currently used in rheumatoid arthritis alot.
I thought I would have a look at the effect on memory B cells. There is not much in multiple sclerosis, but there are a few studies in rheumatoid arthrits and they say the same thing.
The prediction is perhaps clear to me?
So what happens in MS?
Ashtari F, Savoj MR. Effects of low dose methotrexate on relapsing-remitting multiple sclerosis in comparison to Interferon β-1α: A randomized controlled trial. J Res Med Sci. 2011;16(4):457-6
Eighty patients with definite RRMS aged 15 to 55 years were randomly allocated to receive a 12-month treatment course of either oral Methotrexate (7.5 mg/week) or intramuscular Interferon β-1α (30 μg/week). Response to treatment was assessed at 12 months after start of therapy. The results of the study demonstrated significant reduction in relapse rate in both groups (p < 0.01). In 40 patients treated by Methotrexate, the mean value (SD) of relapse rate decreased from 1.75 (0.74) to 0.97 (0.83) (p < 0.01). Correspondingly, the mean value (SD) of relapse rate in patients treated by Interferon β-1α decreased from 1.52 (0.59) to 0.57 (0.78) (p < 0.01).
So not as good as beta interferon in this study:-(
Now I could pull out a paper showimg.methorexate slowed the progression of deterioration of hand function, suggesting promise.
That is not the point.i am trying to make. My point we there a agents that are more potent than others, and this needs to be thought about as putting people on low efficacy options may not be the best plan