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.
|
||||||
Oral Administration |
||||||
Generic/Brand |
Mechanism of Action |
Contraindications |
Adverse reactions |
|||
dimethyl |
Tecfidera |
Induction of nuclear factor 2 (Nrf2), the primary cellular defense against the cytotoxic effects of oxidative stress? |
Hypersensitivity to dimethyl fumurate Progressive multifocal leukoencephalopathy Hepatic disease |
Leukopenia, leukoencephalopathy, angioedema, anaphylactoid reactions, eosinaphilia, elevated hepatic enzymes, ABD pain, DNV, rash, pruritus |
||
teriflunomide |
Aubagio | Pyrimidine synthesis inhibitor that reduces proliferation of peripheral T&B cells, reducing the concentration of activated lymphocytes in the CNS as well as reduced inflammatory phosphlipid synthesis? |
Hypersensitivity to teriflunomide, |
Renal failure, hepatic failure, pancytopenia , Stevens-Johnson syndrome, erythema multiforme, anaphylactoid reactions, hyperkalemia, myocardial infarction, pancreatiti, pulmonary fibrosis, eosinophilic pneumonia, fetal death, teratogenesis |
||
fingolimod |
Gilenya |
Inhibits lymphocyte release from the lymph nodes, decreasing the number of lymphocytes available to migrate to the CNS. |
Hypersensitivity to fingolimod, Recent or current MI, stroke, heart failure |
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 |
||
cladribine |
Mavenclad |
Interferes with DNA synthesis and repair by incorporation into DNA, resulting in sustained reduction of circulating T and B lymphocytes implicated in the pathogenesis of MS |
Current malignancy, pregnant women and persons of reproductive potential, HIV, chronic infections (eg, hepatitis, tuberculosis). |
Upper respiratory infection, headache, low white blood cell count |
||
siponimod |
Mayzent |
Inhibits lymphocyte release from the lymph nodes, decreasing the number of lymphocytes available to infiltrate CNS. |
CYP2C9*3/*3 genotype increases cardiovascular risk. Verify vaccination status, increased infection risk. |
Headache, hypertension, and transaminase elevation; macular edema |
||
Injectable Treatment |
||||||
Generic/Brand | Mechanism of Action | Contraindications | Adverse reactions | |||
peginterferon beta-1a |
Plegridy |
Promotes oligodendrocyte survival, differentiation and axonal recovery by suppressing T-cells associated demyelination and inhibits pro-inflammatory cytokines. Promotes formation of anti-inflammatory cytokines. Inhibits T-cell migration across the blood-brain barrier?
|
Hypersensitivity to natural or recombinant interferon beta or peginterferon |
Injection site reactions |
||
interferon beta-1a |
Avonex |
Albumin hypersensitivity, latex hypersensity, hamster protein hypersensitivity |
Liver failure, cardiac failure |
|||
interferon beta-1a |
Betaseron |
Pregnancy, heart failure, albumin or latex hypersensitivity, breast feeding, depression, immunosuppression, |
Liver failure, cardiac failure |
|||
glatiramer acetate |
Copaxone |
Affects antigen-presenting cells such as monocytes and dendritic cells causing alteration in cytokine secretion by CD4+ and CD8+ T-cells? |
Mannitol hypersensitivity, immunosuppression, infection, pregnancy, breast feeding |
Adverse reactions include injection site reactions, vasodilatation, chest pain, asthenia, infection, pain, nausea, arthralgia, anxiety, and hypertonia. |
||
Intravenous Infusion |
||||||
Generic/Brand |
Mechanism of Action |
Contraindications |
Adverse reactions |
|||
natalizumab |
Tysabri |
Natalizumab is a monoclonal antibody thought to reduce demyelination by interferring with adhesion molecules that facilitate migration T-lymphocytes across the blood brain barrier. |
Progressive multifocal leukoencephalopathy, hypersensitivity, HIV, immunosupression, organ transplant, infection, leukemia |
Headache, fatigue, arthralgia, urinary tract infection, lower respiratory tract infection, gastroenteritis, vaginitis, depression, pain in extremity, abdominal discomfort, diarrhea, rash |
||
ocrelizumab |
Ocrevus |
Monoclonal antibody that inhibits replication of the CD20-positive B lymphocyte cell lines, that damage nerve cells and the myelin sheaths |
Active hepatitis B virus infection, serious infusion reaction. |
Pruritus, rash, urticaria, erythema, bronchospasm, throat irritation, oropharyngeal pain, dyspnea, pharyngeal or laryngeal edema, flushing, hypotension, pyrexia, fatigue, headache, dizziness, nausea, and tachycardia. |
||
mitoxantrone |
Novantrone |
Antineoplastic DNA-reactive agent that intercalates into deoxyribonucleic acid (DNA) forming crosslinks and strand breaks. It also interferes with ribonucleic acid (RNA) and is a potent inhibitor of topoisomerase II, an enzyme responsible for uncoiling and repairing damaged DNA. |
Preexisting cardiac disease, myelosuppression, hepatic disease, pregnancy, breast feeding. |
Neutropenia, GI bleeding renal failure, heart failure, seizures, new primary malignancy, pulmonary edema anaphylactoid reactions, intracranial bleeding, pancytopenia, cardiomyopathy, tissue necrosis
|
||
alemtuzumab |
Lemtrada |
Monoclonal antibody that binds to CD52 on T and B lymphocytes. Binding causes lysis of the lymphocytes reducing T-cells infiltration to the CNS. |
Active tuberculosis, inactive tuberculosis, Listeria monocytogenes infection, HIV, shingles, herpes simplex infection, chronic hepatitis B, Chronic Hepatitis C, protozoa infection. |
Immune thrombocytopenia, autoimmunity, infusion reactions, thyroid disorders, malignancies, glomerular nephropathies, etc. |
||
Instant
Feedback:
Early
use of disease-modifying drugs can slow disease progression and prevent MS relapses.
© RnCeus.com