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Multiple Sclerosis > Disease-modifying Therapies > Flashcards

Disease-modifying Therapies Flashcards

1
Q

Goals of therapy with DMT’s include…

A

Attempt to slow inflammatory process
Decrease frequency + severity of relapses
Decrease lesions on MRI
Reduce accumulation of neurological impairment + disability over time

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2
Q

These DMT’s are injectables…

A

Interferon beta-1a + 1b
Peginterferon beta-1a
Glatiramer acetate
Ofatumumab

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3
Q

These DMT’s are oral…

A

Dimethyl fumurate
Teriflunomide
Cladribine
Fingolimod, Siponimod, Ozanimod, Ponesimod

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4
Q

These DMT’s are infused…

A

Natalizumab
Alemtuzumab
Ocrelizumab
Rituximab

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5
Q

MOA of interferons + glatiramer is ____. They are different than other DMT’s because…

A

Immunomodulating/immounostimulator. Weaker than the other immunosuppressants which knock out specific parts of the immune pathway

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6
Q

Progressive multifocal leukoencephalopathy (PML) is an…

A

Opportunistic infection caused by JC virus

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7
Q

PML causes…

Pathophys + sx’s?

A

Destruction of cells that produce myelin - clumsiness, weakness, changes to vision + speech

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8
Q

If a patient develops PML, we should…

A

“Fix” reason for immune suppression - stop medication, plasma exchange if needed

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9
Q

These immunosuppressants have increased risk of causing PML…

A

Natalizumab
Dimethyl fumurate
Fingolimod
Ocrelizumab

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10
Q

Interferon beta-1b is given…

A

SC every other day

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11
Q

Interferon beta-1a is given…

A

IM once weekly
SC 3x weekly

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12
Q

Peginterferon beta-1a is given…

A

SC every 2 weeks

Less frequent

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13
Q

Common AE’s with the interferon therapies include…

A

Injection site rxn’s
Flu-like symptoms

Hepatotoxicity
Lymphopenia

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14
Q

Glatiramer is given…

A

SC OD or 3x weekly

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15
Q

Ofatumumab is given…

A

SC titration - once weekly, then every 4 weeks

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16
Q

Common AE’s with glatiramer include…

A

Injection site reactions
Post injection systemic reactions
Lipoatrophy

17
Q

Common AE’s with ofatumumab include…

A

Injection site reactions

URTI, headache
Potential for serious infections - PML occurred with high doses

18
Q

Teriflunomide is given…

A

PO once daily

19
Q

Dimethyl fumurate is given…

A

PO BID

20
Q

Common AE’s with teriflunomide include…

A

Diarrhea/nausea, headache
Peripheral neuropathy
Hair thining

Hepatotoxicity

21
Q

All oral DMT’s are ____ and require

A

Potentially teratogenic - males and females

Need adequate birth control

22
Q

Common AE’s with dimethyl fumurate include…

A

GI intolerance
Flushing

Lymphopenia
Rare PML

23
Q

Fingolimod, siponimod, ozanimod, and ponesimod are given…

A

PO once daily

24
Q

Fingolimod is unique in that its AE’s…

A

Are significant for CV AE’s - QT prolongation, bradycardia, AV condution slowing; HTN

Macular edema
Herpes virus infections
Hepatoxicity

Rare PML

25
Q

Siponimod AE’s compared to fingolimod is…

A

Less severe for CV AE’s

Ozanimod and ponesimod have less AE’s in general

26
Q

Cladribine dosing is unique in that…

A

It is weight based
AND
once daily for 4/5 consecutive days beginning of each of the first 2 months of years 1 + 2 of treatment

27
Q

Notable AE’s with cladribine include…

A

Flu-like symptoms (nausea, headache)
Increased infection risk

Potential teratogen in both males + females

28
Q

Natalizumab is given…

A

IV every 4 weeks

29
Q

Ocrelizumab is given…

A

IV at week 0 + week 2, then IV every 24 weeks

30
Q

Notable AE’s with natalizumab include…

A

Increased infection risk
Hepatotoxicity
Hypersensitivity rxn’s

PML especially if 2+ years

31
Q

Notable AE’s with ocrelizumab include…

A

Infusion reactions (pre-medicate with IV corticosteroid + antihistamine)
Increased risk of infection, reactivation of HepB

PML potential
Potential teratogen

32
Q

Alemtuzumab is given…

A

1st course - IV once daily for 5 days
2nd course - IV once daily for 3 days, 12 months after course 1

Additional rounds IV once daily for 3 days, 1 year later.

33
Q

Notable AE’s with alemtuzumab include…

A

Infusion reactions
Development of autoimmune thyroid disorders, blood dyscrasias
Increased risk of infection + malignancy

34
Q

If a patient experiences PML, we could try…

A

Rituximab (off-label for MS)

Multiple Sclerosis (3 decks)

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