New and old: notable drug developments for clinical practice

Abstract

Which drug to use and when for a particular condition is frequently a complex issue relating to individual patient characteristics and circumstance. However, it seems that it was only relatively recently that this quandary was a luxury more commonly associated with non-neurological diseases. However, the last 30 years has seen the exponential development of therapeutic interventions for neurological disease together with increasing and possibly excessive use of trial-related acronyms. Given current requirements for complex trial construction and meeting of regulatory demands, the development of a novel proven therapeutic intervention in area of need is no mean task and commonly followed by a prolonged period where indications are refined and then a more pragmatic analysis of treatment algorithms ensues. In Journal Club, this month we examine results for a new oral treatment for relapsing multiple sclerosis (MS) in the form of a placebo-controlled trial of laquinimod. It is perhaps a statement of advances made in MS treatments to date that this trial may finally herald the end of the placebo arm in controlled trials in relapsing MS. The results of this trial by contemporary standards, while demonstrating some limited effectiveness, might be considered disappointing. In turn, this then begs the question as to where the place of laquinimod might be in the expanding arsenal of treatments for relapsing disease. Secondly, we look at a head-to-head trial of intravenous alteplase and a potential alternative thrombolytic agent for acute ischaemic stroke. Finally, we review the latest output from the SANAD (Standard and New Antiepileptic Drug) trial, which examines prognostic factors for time to treatment failure across a wide range of standard antiepileptic drug interventions for focal epilepsy.