MS Disease Modifying Therapies

Question 1

Interferon-beta-1b

Answer 1

Betaseron
injectable
subcut every other day
CBC and LFT q6months

Question 2

Interferon-beta-1a

Answer 2

Avonex
injectable
IM weekly
CBC and LFT q6months

Rebiff (most effective injectable)
injectable
subcut 3x per week
CBC and LFT q6months

Question 3

Peginterferon beta-1a

Answer 3

Plegridy
injectable
subcut q2weeks
CBC and LFT q6months

Question 4

Glatiramer acetate

Answer 4

Glatect or Copaxone 20
injectable
subcut OD
No monitoring
Lipoatrophy

Question 5

Ofatumumab

Answer 5

Kesimpta
injectable
First 3 weeks (SC q1week), then SC q1month
CBC and LFT q6months
RIsk of serious infection or PML (less than natalizumab)

Question 6

Teriflunomide

Answer 6

Aubagio
oral
OD
LFT monthly for first 6 months, then q6months
CBC
Hair thining (not desirable for women)
Teratogen M&F (baseline preg, test and contraception even 2 years after d/c)

Question 7

Dimethyl fumarate

Answer 7

Tecfidera
oral
BID
CBC
Flushing and lymphopenia (many patients switched off)

Question 8

FIngolimod

Answer 8

Gilenya
oral
OD
LFT, varicella, ECG(cardiac observation for first dose), ophthalmological, pregnancy
Teratogen
Only DMT indicated for use in children with MS

Question 9

Siponomod

Answer 9

Mayzent
oral
OD
No cardiac observation for first dose
CBC and LFT
Also indicated for secondary progressive MS
Teratogen

Question 10

Ozanimod

Answer 10

Zeposia
oral
OD
CBC and LFT
Teratogen
non-formulary

Question 11

Cladribine

Answer 11

Mavenclad
oral
OD for first 5 days of first two months of treatment years 1 and 2
Teratogen (baseline pregnancy test), varicella test, CBC
Monitor for TB, Hep B & C infections
Stronger immunosuppressive effect

Question 12

Natalizumab

Answer 12

Tysabri
infusion (IV)
IV q4weeks
Baseline JC virus, MRI, CBC, LFT
Then q6-12 months
PML potential (highest risk DMT esp. after 2 years of therapy)
Potential teratogen
rebound symptoms if stopped

Question 13

Ocrelizumab

Answer 13

Ocrevus
infusion (IV)
for first two weeks (q1week) then q6months
Also indicated for primary progressive MS
Premedicate with antihistamine before infusion
Avoid if pt. has HepB
Avoid pregnancy for 6 to 12 months
PML potential

Question 14

Alemtuzumab

Answer 14

Lemtrada
infusion (IV)
first course (OD for 5 days)
second course given at month 12 (OD for 3 days)
Lots of ADRs and monitoring
Thought to be permanent solution, has not worked out that way

Question 15

Rituximab

Answer 15

off-label use
infusion (IV)
Potential for PML
Cost-effective and high efficacy