I just had a long discussion about this issue with the Novartis rep and I find the present commentary very interesting. There seems to be a lot of interest is risk assessment with various drugs and other activities. Other meds come to mind such as Depakote, Clozaril, Vioxx, Bextra, tolcapone, Felbamate, Zyprexa in the elderly, etc. There are death rates with all of these.
Some are risk adverse, while others will take a chance on M&M for a good benefit. There was a survey on Tysabri that basically asked what chance of death would be acceptable to you for good control of MS. Some go for treatment at 1:1000 death rate, while others require 1:10,000 or 1:100,000. Where will Gilenya be in 1-2 years?
At this point, I would like more details on all of the patients who have died on Gilenya, even the ones who drowned. Sometimes drowning is related to bradycardia, sometimes the current is just too swift.