MS

Question 1

Interferon beta1a (Avonex, Rebif)
Interferon beta1b (Betason, Extavia)

Answer 1

Inhibits autoreactive lymphocytes (T cells and Dendritic cells) in the periphery
Inhibits BBB penetration by decreasing MMP, which usually destroys the BBB and makes it easier to get in
1st line
Can cause depression, flu like reactions
Injectable

Question 2

Glatiramer acetate (Copaxone)

Answer 2

Myelin-mimic peptide that binds to T cells and dendritic cells and inhibits activation
1st line
Pregnancy category B
Injectable

Question 3

Fingolimod (Gilenya)

Answer 3

Prevents cells from leaving lymp
enhances oligodendrocyte survival and promotes remyelination
1st line
AE: lymphocytopenia, AV block, PML (but not a boxed warning), avoid live vaccines
REMS FOR AV BLOCK, MUST STAY IN CLINIC FOR 6 HOURS
ORAL

Question 4

Natalizumab (Tysabri)

Answer 4

neutralizes a4-integrin, which normally binds to VCAM-1 in the BBB to allow access. B and T cells can no longer be transported into CNS
2nd line
AE: PML (must check for JCV antibodies before initiation), depression
Injection

Question 5

Mitoxantrone (Novantrone)

Answer 5

decreases number of lymphocytes by breaking DNA and inhibiting topo II
Used as induction therapy
CV TOXICITITY LAST LINE THERAPY
Injection

Question 6

Teriflunomide (Aubagio)

Answer 6

Prevents pyrimadine biosynthesis
Inhibits proliferation of activated B and T cells
TERATOGENIC
Hepatotoxicity, SJS, neutropenia
ORAL

Question 7

Dimethyl fumarate (Tecfidera)

Answer 7

Activates NrF2-mediated cellular antioxidant/anti-inflammatory response
May promote remyelination
Suppresses activated T cells and DCs in periphery
LFTs, lymphocytopenia, albuminuria, infections
ORAL

Question 8

Alemtuzumab (Lemtrada)

Answer 8

targets CD52 (a marker on immune cells)
Treats MS in pts who have not had a response to 2 treatment options
REMS- HAVE TO STAY IN CLINIC FOR 2 HOURS TO MONITOR
Premedicate with steroids
CI in HIV
increases risk of CANCER
No live vaccines

Question 9

Daclizumab (Zinbryta)

Answer 9

targets CD25 on T cells
REMS
diaphoresis, shivering, flu-like symptoms, skin reactions, mouth ulcers, seizures, N/V, tiredness, loss of appetite, mood changes
Injection

Question 10

Dalfampridine

Answer 10

blocks K+ channels and prevents repolarization to prolong action potentials and nerve impulse transmissions in demyelinated axons which may improve walking speed