This variant is better than the other variant, not more effective, but safer.

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We have had a bit of marketing with the mod manufactureres saying “don’t buy their imod but ours, not because it is better but because it is is safer”.

Comparative safety and efficacy of ozanimod versus fingolimod for relapsing multiple sclerosis. Swallow E, Patterson-Lomba O, Yin L, Mehta R, Pelletier C, Kao D, Sheffield JK, Stonehouse T, Signorovitch J. J Comp Eff Res. 2020 Jan 17. doi: 10.2217/cer-2019-0169. [Epub ahead of print]

However, we know that fingolimod targets S1P3 which causes cardiac issues which ozanimod is lacking because it doesn’t bind S1P3. However neither does siponimod, so is there a difference between ozanimod and siponimod? In the US you can ask that question as it is approved from RRMS as well as SPMS. In Europe I suspect you are not going to get the option as it is approved for active SPMS only.

Now we have another publication on the fumarate where the same manufacturer essentially is saying the same thing, the new variant is not more effective, nor is it more convenient at twice a day, but it is is safer and has less side effects.

Diroximel Fumarate Demonstrates an Improved Gastrointestinal Tolerability Profile Compared with Dimethyl Fumarate in Patients with Relapsing-Remitting Multiple Sclerosis: Results from the Randomized, Double-Blind, Phase III EVOLVE-MS-2 Study. Naismith RT, Wundes A, Ziemssen T, Jasinska E, Freedman MS, Lembo AJ, Selmaj K, Bidollari I, Chen H, Hanna J, Leigh-Pemberton R, Lopez-Bresnahan M, Lyons J, Miller C, Rezendes D, Wolinsky JS; EVOLVE-MS-2 Study Group. CNS Drugs. 2020 Jan 17. doi: 10.1007/s40263-020-00700-0. [Epub ahead of print]

This study was called EVOLVE, I wonder if they had considered the trial called FLEECE. However this is part of the product recycling apporach. As an agent comes up to its sell-by patent date, the agent is repurposed, to make the new variant look better.

So one a week beta interferon became once a fortnight pegulated interferon, 20mg daily copaxone became thrice a week 40 mg copaxone, and alemtuzmab, became..I forgot they canned the follow-on antibody,

The distinct chemical structure of DRF is hypothesized to elicit less irritation in the GI tract (intestine) than DMF through lower production of methanol and less reactivity with pre-systemic off-target proteins or receptors. In the states the list price is I believe $88,000 per year of treatment for DRF verses perhaps over $100,000 for Dimethyl fumarate so grab your self a bargin. Maybe we can sink DMF before it goes generic.

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