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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.

There are currently 5 FDA approved immunomodulating drugs used to treat relapsing and/or progressive forms of MS:

interferon beta 1a (Rebif®);
interferon beta 1a (Avonex®);
interferon beta 1b (Betaseron®;
glatiramer acetate (Copaxone®;
natalizumab (Tysabri®) administrated only through a restricted prescribing program

Mitoxantrone (Novantrone®), is an approved immunosuppressant drug used to treat relapsing remitting and/or progressive forms of MS.


Name	Class	Administration	Common Side Efects	Black 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

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.

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.