Overview MS Medications

MS inflammatory drugs

There are several products on the market to treat multiple sclerosis that can slow disease activity. There is a difference between first-line and second-line drugs and the drugs are effective in many different ways with several possible side effects. The following list is intended to ease the comparison and being able to have a good conversation with your neurologist, for example when choosing or switching between drugs.

 

First line medication:

After being diagnosed, a neurologist will advise you to choose from a number of first-line drugs. The choice may depend on, for example, your preference of usage (oral or injectables), or based on possible side effects. Actually, there is not a “best” choice, it is very much depending on your personal situation and symptoms.

  • Interferon-Beta (Avonex, Rebif, Plegridy, Betaferon)
  • Copaxone
  • Aubagio
  • Tecfidera

 

Second line medication:

Second-line drugs should only be prescribed by a doctor after the verification that first-line drugs have failed or if the MS shows a very active and aggressive course of disease activity. In example, the prerequisites of some of these medications could be 2 failing first-line medications.

  • Tysabri
  • Gilenya
  • Lemtrada
  • Rituxin

 

Medications to be expected (waiting to be FDA approved):

  • Ocrevus (Ocrelizumab) – Testing phase III was finalized, expected availability in December 2016 / 2017, depending on FDA approval. (Source – June 2016: Roche Media Release and MSweb)

 

 

MS medications Comparison chart 1

~Dosing & Effects~

First line Medication
Brand name
Active substance
MS type
Dosing How often? Suppressive effect
Avonex Interferon bèta-1a RRMS injectable 1x per week Relapse reduction of 30-33%. Holding back of physical deterioration.
Rebif Interferon bèta-1a RRMS injectable 3x per week Relapse reduction of 30-33%. Holding back of physical deterioration.
Plegridy Interferon bèta-1a RRMS injectable 1x per 2 weeks Relapse reduction of 35%.
Betaseron Interferon bèta-1b RRMS injectable Every other day Relapse reduction of 30-33%. Holding back of physical deterioration.
Extavia Interferon bèta-1b RRMS injectable
Copaxone glatiramer acetate RRMS injectable Daily or 3x per week Relapse reduction of 29%
Glatopa glatiramer acetate RRMS injectable
Zinbryta Daclizumab RRMS injectable
Aubagio Teriflunomid RRMS oral 1x per day Relapse reduction of 29%
Tecfidera Dimethyl fumarate RRMS oral 2x per day
Second line Medication
Brand name
Active substance
MS type Dosing How often? Suppressive effect
Gilenya Fingolimod RRMS oral Daily Might reduce the relapse rate by  54-71%.
Tysabri Natalizumab RRMS infused 1x per month Clinical research has shown that the risk of physical deterioration is halved.
Lemtrada Alemtuzumab RRMS infused 1st Course: 1x per day, 5 days in a row. 2nd Course: a year later, 1x per day, 3 days in a row. 30% Improval of disability. After 5 years around 40% of the patients remain NEDA.
Novantrone Mitoxantrone RRMS + SPMS infused
Medications to be expected
Ocrevus Ocrelizumab RRMS + PPMS infused  1x per 6 months Relapse reduction of 95%, slowing down of physical deterioration with 40%.

 

 

MS medications Comparison chart 2

~Efficacy vs. side effects~

First line Medication
Brand name Since What does the medicine do? Most common side effects
Avonex 1995 Interferons are natural proteins produced by the body itself and play a role in the immune system and combating diseases. Made from a culture of mammalian cells, and has the same composition as the human product. Flu-like symptoms (which disappear after a day). Reactions at the injection site such as pain and inflammation. Less common side effects include depression and anxiety, palpitations, loss of appetite, hair loss, insomnia and nervousness.
Rebif 1996 identical to Avonex Reactions at the injection site, such as redness or slightly painful. Less common side effects are flu-like symptoms, palpitations, back pain, flushing, nausea, vomiting, diarrhea, rashes, insomnia and nervousness.
Plegridy 2015 Interferon which is differently prepared which provides a prolonged drug delivery.
Betaferon 1996 Reactions at the injection site (80%): the skin swollen, red and painful. Other side effects include: flu-like symptoms, fatigue, menstrual disorders and depression. Decrease in side effects often after 3 months and reduce ibuprofen.
Copaxone 2004 Consists of pieces of synthetic protein resembling myelin, reducing the damage to and inflammation of myelin. Reactions at injection site, flushing, chest pain, shortness of breath or palpitations. Stomach / intestinal problems, joint pain and back pain.
Aubagio 2013 Inhibits the division of a particular type of activated white blood cells responsible for the inflammatory process in MS.
Tecfidera 2013 The exact effect of the drug is not entirely clear. Dimethyl fumarate seems to ensure that the immune system doesn’t damage the brains and spinal cord. Flushing, stomach problems, and the white blood cells may decrease. Small risk of PML.
Second line Medication
Gilenya 2012 Gilenya passes the blood-brain barrier, and binds to the T-cells (white blood cells) whereby it does not attack the body’s own myelin layer in order to reduce inflammation and damage to nerve tissue. Increased risk of infection (in particular, lung infection), cardiac arrhythmia’s and heart failure. Presumably lower risk of PML than Tysabri.
Tysabri 2006 Monoclonal antibody (protein) that prevents white blood cells (T-cells) to reach the central nervous system (blood-brain barrier) and the nerve cells. The inflammation and damage in MS relapses is caused by those T-cells in the brain and spinal cord. Shortly after infusion: headache, dizziness, tiredness, rash, itching, fever and chills. Main serious side effect: risk of PML. This risk is monitored by means of blood test for JC virus. The PML risk increases after 24 months / infusions.
Lemtrada 2014 Partial destruction of the immune system. Lemtrada binds to a specific protein, which is located on the white blood cells and which are responsible for attacking the myelin. Lemtrada breaks off the pathogenic cells (B and T cells). After this, the body will create new white blood cells that produce fewer or no attacks on the nervous system. Was formerly used in leukemia (Campath), is then adapted for use in MS as Lemtrada. Infusion-related reactions during treatment, such as headaches, nausea, fever, rash and fatigue. Increased risk of infections and the main serious side effects are a risk of thyroid disease / cancer, melanoma, too few platelets and certain kidney disorders.
Medications to be expected
Ocrevus Dec. 2016 Targets a type of white blood cell called B lymphocytes. The first drug to be effective in PPMS, besides RRMS. Not released yet. Under trial.

 

More information and explanation on medications?

The website of the National MS Society is very helpful to consult for additional and up-to-date information. Also an overview of medications to manage symptoms can be found at this page.

 

 

Sources: The information in the tables is based on information released by the manufacturers websites, books and manuals (Bayer, Biogen, EMD Serono, Genzyme, Novartis, Teva). Also Wikipedia.

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