Overview of the injectable medications, and several pills, currently available in the U.S. for treatment of MS.
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Avonex FDA- approved
* weekly low dose interferon
* for relapsing-remitting MS
* protects against severe relapses
* intramuscular injection once a week
* side effects: flu like symptoms
* depression and liver dysfuntion less common
* approved in 1996
Betaseron and Extavia (interferon-beta-1b) FDA-approved
* subcutaneous (under skin) injection every other day
* interferon
* for relapsing-remitting, first symptom, and progressive-relapsing MS
* reduces relapse rate
* side effects: flu like symptoms, injection site reactions
* can cause depression
* approved in 1993
Rebif (interferon-beta-1a) FDA-approved
* subcutaneous injection three times a week
* interferon
* for relapsing-remitting MS
* reduces relapse rate
* side effects: flu like symptoms
* approved in 2002
Copaxone (glatiramer acetate) - FDA approved
* daily subcutaneous injection
* noninterferon, probably safest medication for MS
* skin redness, itching, and dimpling common
* for relapsing-remitting MS and first symptom MS
* reduces relapse rate
* improvement on MRI activity
* takes 6-12 months to be most effective
* extremely safe
* side effects: injection site reactions such as
swelling, redness, pain
* approved in 1996
Novantrone (mitoxantrone) FDA- approved for MS
* powerful immunosuppressive medication - rarely used
* chemotherapy agent
* for secondary prgoressive, progressive relapsing, and some
types of relapsing-remitting MS
* reduces relapses and lengthens time between relapses
* IV infusion once every three months
* side effects: risk of heart muscle injury (5%) and leukemia (1%)
* nausea, hair loss, menstrual disorders (permanent menopause)
* improvement compared to other treatments
* approved in 2000
Tysabri (natalizumab) approved for MS
* antibody that makes it difficult for immune system cells to
move into the brain and spinal cord
* for relapsing remitting MS that has not responded
to other treatment
* reduces relapse rate
* IV infusion once every four weeks
* 1/3 of patients improve in disability, suppresses 90% of MRI disease
* increases risk (1:1000) of viral infection of the brain
* infrequent side effects: headache, pain, fatigue, diarrhea, depression
* approved in 2006
Azathioprine (Imuran), leflunomide (Arava), and Methotrexate - not appreved for MS
* immunosuppressive medications in pill form
* rarely used as therapy at first due to their
increased risk
Gelinya (fingolimod) FDA approved
* mild immunosuppressive/immunomodulatory medication in pill form
* good safety profile, but some risks require consideration and monitoring
* first dose usually give in doctors office
* 1:200 risk of eye (macula) swelling
* 1:200 risk of symptoms with slow heart rate on first dose
* Need to have had chickenpox or vaccine at least 30 days before
* Monitr for liver stress
* Need bullet-proof reliable contraceptive
Alemtuzumab (CAMPATH) not yet approved for MS
* immunosuppressive medication - powerful
* rarely used as therapy at first due to their increased risk
* risk of automimmune complications
* bleeding (ITP) in 2-3 %
* thyroid dysfunction in about 20%
* appears more powerful than interferon-beta
Rituximab (Rituxan)
* immunosuppressive iv medication
* usually used as rescue therapy in very severe MS
* rarely used as therapy at first due to increased risk
* risk of serious infections
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