The National MS Society
Medical Advisory Board supports early intervention with disease modifying drugs
to prevent relapses. Studies show that early relapses can cause permanent axonal
damage and destruction of myelin. The Medical Advisory Board recommends that
therapy with a disease-modifying drug should be started as soon as a diagnosis
of relapsing-remitting MS is made, and that therapy should be continued indefinitely
unless there is a clear lack of benefit, intolerable side effects, or until
a better therapy is found.
Early use of disease-modifying drugs can slow disease progression and prevent MS relapses.
FDA approved disease modifying medications used to treat relapsing and/or progressive forms of MS:
Mitoxantrone (Novantrone®), is an approved disease modifying agent used to treat relapsing remitting and/or progressive forms of MS.
|Name||Class||Administration||Common Side Efects||Warning|
|Aubagio®||pyrimidine synthesis inhibitor||Oral pill once a day||Hair thinning, diarrhea, flu, nausea, abnormal liver tests and unusual numbness or tingling in the hands or feet (paresthesias). Less common: lowered levels of white blood cells, which can increase the risk of infections; increase in blood pressure; severe liver damage||Black Box Warning|
|Rebif®||interferon beta-1a||Subcutaneous injection 3 times a week||Flu-like symptoms, allergic reactions, depression, hepatic and hematopoietic abnormalities|
|Avonex®||interferon beta-1a||Intramuscular injection once a week||Flu-like symptoms, allergic reactions, depression, hepatic, hematopoietic and cardiac abnormalities|
|Betaseron®||interferon beta-1b||Subcutaneous injection every other day||Flu-like symptoms, allergic and injection site reactions, depression, hepatic and hematopoietic abnormalities|
|Copaxone®||L-glutamic acid polymer||Subcutaneous injection every day||Injection site reactions, vasodialtion, flushing, chest pain, SOB|
|IV infusion every four weeks.||Headache, fatigue, arthralgia, urinary tract infection, lower respiratory tract infection, gastroenteritis, vaginitis, depression, pain in extremity, abdominal discomfort, diarrhea, rash||Black Box Warning|
|Novantrone®||antineoplastic||IV infusion four times a year||Blue-green urine 24 hours after administration; infections, bone marrow suppression, nausea, hair thinning, loss of menstrual periods, bladder infections, and mouth sores||Black Box warning|
|Gilenya||sphingosine 1-phosphate receptor modulator||Oral capsule||Headache, myalgia, diarrhea, back pain, abnormal liver tests, and cough. Rarely: death or bradyarrhythmia and atrioventricular block at treatment initiation, infections, macular edema, respiratory effects, hepatic effects, and fetal risk||FDA Warning|
Although these drugs are not a cure for MS, they have each been shown to slow or modify the course of the disease. Tysabri and Novantrone have significant negative side effects and risks; please view the black box information. Gilenya has recently undergone an FDA safety review following reports of death and serious side effects.
Other immunosuppressive agents such as azathioprine (Imuran ®), cladribine (Leustatin ®), cyclophosphamide (Cytoxan ®), and methotrexate are also used for progressive forms of MS. As these agents are used to treat cancer, they are used in lower doses in MS therapy. However, patients may experience side effects such as hair loss and nausea and may be at risk for long-term side effects including sterility, cardiotoxicity, and liver toxicity.
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