As 2012 draws to a close, it is time to reflect on what is likely to be an interesting and exciting year for neurology in 2013. Basic science understanding of brain function, in particular genetics and epigenetics, will continue to grow, as will hopefully our understanding of the pathophysiology of the degenerative, inflammatory and episodic diseases that make up most neurological practice, such as Parkinson’s disease, MND, multiple sclerosis and even migraine.
More importantly for patient care, there is likely to be a real wave of new neurological drugs available on the PBS for patients with neurological diseases. In great news for patients with neuropathic pain, pregabalin (Lyrica) is to be PBS listed for this indication. This will open up options for those undertreated at the moment, and provide a huge financial relief to those patients already on the medication. We have also seen the introduction of a new medication for Parkinson’s (rasagiline/Azilect), that I have found to be a useful adjunct for a number of patient’s thus far, with minimal side effects.
The biggest revolution will be in MS care, with TGA approval of the second oral medication in MS just announced. Teriflunomide (Aubagio) could be a good option for many MS patients, and as many of you may know, the currently available agent fingolimod (Gilenya) has had a huge uptake in MS patients, becoming the most prescribed MS drug within 12 months. Also to come in 2013 is a third oral, BG12. I have had extensive experience with these medications from the clinical trials, as an investigator on trials of all three agents in my work at the Austin Hospital, and will be registered for the early access schemes of these medications. So I hope to be able to discuss these options with your MS patients over the next few months. Finally, I am just back from a trip to Dallas, where I represented the Austin at a meeting outlining a new trial for patients with secondary progressive multiple sclerosis. Progressive MS patients still unfortunately have minimal treatment options available, so this trial (still to be approved by ethics in Australia, but likely to be up and running around January) provides a real option for SPMS patients under the age of 60 to participate in research. I am happy to discuss this with your patients also if and when it is up and running.
Dr Nicholas Crump