As I said I don’t know a lot about tecfidera, although the comments on here have certainly inspired me to find out more. And to do some more research generally - which perhaps I should have done already but there you go!
So tecfidera does look promising: but the evidence is still fairly limited. Having read both the NICE evaluation of Tecfidera, the Cochrane review of the Tecfidera studies, and several other papers, I am not convinced that it’s obviously better than the other available first line DMDs. Not to the point where I’m ready to give my neurologist a slap anyway!
There are no studies that directly compare beta interferons with Tecfidera.
There is one study that compares directly with GA, and shows that Tecfidera may be better than GA at reducing relapse rates, but with no significant difference on disability progression. GA is thought to be broadly similar in effectiveness with interferons, implying that Tecfidera may have some improvement on ovearll relapse rates compared with interferons. However the NICE report made clear that the relative treatment effects are uncertain at this stage due to difficulties in making a fair comparison among the various treatment options - e.g. the studies did not all test the same things.
As against that, there is some evidence that for certain groups of people interferons are more effective than the overall 30% number would suggest. For example they seem to be more effective specifically for those who (like me) are being treated early in the course of their MS. There is also, anecdotally at least, a suggestion that the c. 30% figure for interferons is not an across-the-board effect due to the fact that there are groups of people that don’t seem to get any benefit from it i.e. it either works brilliantly or it doesn’t really work much at all. There is also better safety data (not saying the Tecfidera safety data is poor, only that interferon has more trials over a longer period and apparently fewer serious side effects).
Based on the above, I’m not unhappy with the recommendation I received and the decision made to start with Avonex. The first week was pretty rough although I now suspect that it was a generalised anxiety rather than a specific side effect of the injection. The last 2 weeks have been fine with just some modest aches and pains easily managed with paracetemol.
I realise not everyone gets on with this drug - which it is why it’s great that there are options - but having now done the research that I perhaps should have done before, on the whole I’m not sorry to be giving it a try.
Also, I’ve spent most of an evening reading MS things now, so I’m off to guzzle some chocolate before bed