The first hurdle is beating the current cheap and well known oral drug - methotrexate on safety and efficacy. Then there are the new and advanced oral drugs in development: Pfizer's tofacitinib and CELG’s apremilast. Fumaderm is very effective but has SE like flushing, nausea, vomiting and diarrhea in 30% of patients which typically limit the treatment period to 4-6 weeks plus it is only approved in the EU and mainly in use in Germany.
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