Disease Modifying Agents

National recommended practice guidelines advocate early immunomodulating treatment to slow disease progression and help prevent irreversible neurological damage. Pharmacological management of this complex disease also involves treating acute attacks, managing symptoms, and monitoring interactions among medications, and between the disease process and the medical therapy.

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.


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Early use of disease-modifying drugs can slow disease progression and prevent MS relapses.

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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  
Tysabri®

monoclonal antibody

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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