What are the disease-modifying therapies used in the treatment of multiple sclerosis (MS)?

Updated: Feb 21, 2019
  • Author: Fiona Costello, MD, FRCP; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

Answer

Disease-modifying therapies (DMT) decrease clinical and subclinical CNS inflammation with the intention of reducing the accumulation of disability and disease progression. These medications are used in the management of patients with RRMS, patients with clinically isolated syndrome (CIS) who are at risk of developing MS, and patients with SPMS. Because of the chronic nature of MS and the potential adverse effects of therapy, treatment needs to be tailored to the needs of the patient, ideally by a clinician with expertise in managing the disease.

Table 2. Disease-Modifying Therapies Used in the Treatment of Multiple Sclerosis [6, 7, 8, 9]   (Open Table in a new window)

Drug

Route

MS Subtype

Dosing Frequency

Adverse Effects

Interferon β-1a (Avonex)

Intramuscular

Relapsing forms of MS, CIS

Once weekly

Flulike symptoms, liver enzyme changes, bone marrow suppression, thyroid dysfunction

Interferon β-1a (Rebif)

Subcutaneous

Relapsing forms of MS, CIS

22 mcg or 44mcg three times weekly

Flulike symptoms, liver enzyme changes, bone marrow suppression, thyroid dysfunction

Interferon β-1b (Betaseron)

(Extavia)

Subcutaneous

Relapsing forms of MS, CIS

Three times weekly

Flulike symptoms, liver enzyme changes, bone marrow suppression, thyroid dysfunction

Glatiramer acetate (Copaxone)

Subcutaneous

Relapsing forms of MS, CIS

Daily

Skin irritation, skin lipoatrophy, panic attack–like events

Natalizumab (Tysabri)

Intravenous

Relapsing forms of MS

Once monthly

Nausea, infection, liver dysfunction, progressive multifocal leukoencephalopathy (PML)*

Fingolimod (Gilenya)

Oral

Relapsing forms of MS

Daily

Macular edema, bradyarrhythmia, QT interval prolongation, hypertension, severe varicella-associated complications in nonimmune patients, increased risk of herpes zoster in all patients, mild infections, PML (rare)

Dimethyl fumarate (Tecfidera)

Oral

Relapsing forms of MS

Twice daily

Flushing, gastrointestinal distress, rare lymphopenia, PML (rare)

Teriflunomide (Aubagio)

Oral

Relapsing forms of MS

Once daily

Nausea, headaches, alopecia, liver dysfunction, presumed teratogenicity

Alemtuzumab (Lemtrada)

Intravenous

Relapsing forms of MS

Minimum of two cycles (baseline and year one)

Infusion reactions, mild-moderate infections, thyroid dysfunction, idiopathic thrombocytopenic purpura, anti-glomerular basement membrane disease [6]

Daclizumab (withdrawn from market)

Subcutaneous

Relapsing forms of MS**

Monthly

Mild-moderate infections, allergic reactions, dermatitis/rash, lymphadenopathy, oropharyngeal pain, liver irritation, depression [7]

*Progressive multifocal leukoencephalopathy (PML) risk increases with a history of immunosuppression, JC virus positivity, and use of the drug >2 years. Risk for the entire cohort is roughly 3-4/10,000. [8]

** The US Food and Drug Administration has recommended this drug be used only if the patient manifests an inadequate therapeutic response to 2 or more other DMTs.


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