MS Drugs Flashcards
IFN-beta-1a (Avonex)Misc
Doesn’t cross BBB; decreases relapse rate by 1/3 and reduces MRI lesions, with a trend toward decreasing disability and brain atrophy
IFN-beta-1a (Avonex) Class
IFN-beta-1a
IFN-beta-1a (Rebif) Class
IFN-beta
Glatiramer acetate (Copaxone) Class
Myelin basic protein analog
Natalizumab (Tysabri) Class
Monoclonal antibody
Fingolimod (Gilenya) Class
Sphingosine-1-phosphate analog
Mitoxantrone (Novantrone) Class
Anthracenedione
Azathioprine (Imuran) Class
Immunosuppressants
Methotrexate (Trexall) Class
Immunosuppressants
Cyclophosphamide (Cytoxan) Class
Immunosuppressants
Mycophenolate mofetil (CellCept) Class
Immunosuppressants
Methylprednisone (MTP) Class
Corticosteroid (immunosuppressant)
IFN-beta-1a (Avonex) MOA
Many, potentially: inhibit T-cell activation, shift from Th1 to Th2, inhibit lymphocyte movement into CNS, anti-proliferative effect, apoptosis of T-cells, anti-viral, IFN-g antagonism
IFN-beta-1a (Rebif) MOA
Many, potentially: inhibit T-cell activation, shift from Th1 to Th2, inhibit lymphocyte movement into CNS, anti-proliferative effect, apoptosis of T-cells, anti-viral, IFN-g antagonism
Glatiramer acetate (Copaxone) MOA
Mixture of 4 AAs in myelin basic protein; causes T-cell apoptosis (looks like MBP), induces anti-inflammatory Th2 cells (cytokine shift from Th1), induces Treg with induction of anergy
Natalizumab (Tysabri) MOA
Binds VLA4 (integrin subunit), inhibiting leukocyte migration across BBB
Fingolimod (Gilenya) MOA
Prodrug; sequesters circulating lymphocytes in secondary lymphoid organs via induction of intracellular internalization of receptors on lymphocytes (no effect on lymphocyte induction, proliferation, or memory function)
Dimethyl fumarate (Tecfidera) MOA
Enhances Nrf2 pathway; some Th1 -> Th2 sgift
Mitoxantrone (Novantrone) MOA
Broad immune suppression and modulation of B cells, T cells and macrophages; decreases frequency of clinical relapse, reduces disease progress, and reduces disability
Azathioprine (Imuran) MOA
Immunosuppressive
Methotrexate (Trexall) MOA
Immunosuppressive
Cyclophosphamide (Cytoxan) MOA
Immunosuppressive
Mycophenolate mofetil (CellCept) MOA
Immunosuppressive
Methylprednisone (MTP) MOA
Unclear mechanism (suppress both B and T cells, may reduce cytokine release)
Plasmapharesis MOA
Unclear mechanism
IFN-beta-1a (Avonex) Therapeutics
RRMS
IFN-beta-1a (Rebif) Therapeutics
RRMS (high-dose); first-line treatment (more efficacious than Avonex in head-to-head trials)
Glatiramer acetate (Copaxone )Therapeutics
RRMS
Natalizumab (Tysabri) Therapeutics
RRMS (2nd line)
Fingolimod (Gilenya) Therapeutics
RRMS
Dimethyl fumarate (Tecfidera) Therapeutics
Mitoxantrone (Novantrone) Therapeutics
SPMS; RRMS (2nd line)
Azathioprine (Imuran) Therapeutics
SPMS (resistant, or as combination with other therapies)
Methotrexate (Trexall) Therapeutics
SPMS (resistant, or as combination with other therapies)
Cyclophosphamide (Cytoxan) Therapeutics
SPMS (resistant, or as combination with other therapies)
Mycophenolate mofetil (CellCept) Therapeutics
SPMS (resistant, or as combination with other therapies)
Methylprednisone (MTP) Therapeutics
Acute MS attack, SPMS; shortens acute attack duration,speeds recovery
ACTH Therapeutics
Acute MS attack (if patient allergic to corticosteroids, poor IV access); or if MTP doesn’t work
Plasmapharesis Therapeutics
Acute MS attack not responsive to MTP
IFN-beta-1a (Avonex) SE
- Mild anemia, increase LFT (monitor every 6 mo.), hypothyroid; least NAB formed 2. Flu-like, minor irritation at inject site, anemia
IFN-beta-1a (Rebif) SE
- Anemia, leukopenia, menstrual irregularities, depression, increase LFT and hypothyroidism (monitor every 3 mo.) 2. Flu-like, injection site reaction; neutropenia; thrombocytopenia
Glatiramer acetate (Copaxone ) SE
Mild: injection site reaction, anxiety attack-like reaction
Natalizumab (Tysabri) SE
- PML (JC virus); acute urticaria, systemic hypersensitivity infusion reaction 2. Headache, dizziness, fatigue, arthralgia, rigors
Fingolimod (Gilenya) SE
- Bradycardia and heartblock (EKG for first 6 hours); macular edema (need opthalmology exam before and after 3 months) 2. Reduced FEV1, increased LFTs, lymphopenia, leukopenia, asthenia, back pain, blurred vision, headache dizziness, infections
Dimethyl fumarate (Tecfidera) SE
- N & V; diarrhea; stomach pain; flushing 2. Itching, redness, rash
Mitoxantrone (Novantrone) SE
- Dose-dependent cardiac toxicity (decreased LVEF, irreversible CHF); induction of acute leukemia 2. Nausea and vomiting, alopecia, menstrual irregularities, increased susceptibility to infection
Azathioprine (Imuran) SE
Systemic toxicity: monitor blood for changes
Methotrexate (Trexall) SE
Systemic toxicity: monitor blood for changes
Cyclophosphamide (Cytoxan) SE
Systemic toxicity: monitor blood for changes
Mycophenolate mofetil (CellCept)SE
Systemic toxicity: monitor blood for changes
Methylprednisone (MTP) SE
Short-term: insomnia, mood changes, fluid retention, epigastric pain, hypertension; long-term: osteoporosis, cushingoid, secondary malignancies
IFN-beta-1a (Avonex)Misc
Doesn’t cross BBB; decreases relapse rate by 1/3 and reduces MRI lesions, with a trend toward decreasing disability and brain atrophy
IFN-beta-1a (Rebif) Misc
As with Avonex; significantly reduces new and enhancing MRI lesions, reduces disablity
Glatiramer acetate (Copaxone ) Misc
Active in CNS (not peripherally); try to use early; reduce relapse by 1/3, modest reduction in MRI lesion and reduction of atrophy, but no effect on disease progression
Natalizumab (Tysabri) Misc
Decrease relapse rate by 2/3, greatly reduce MRI lesions; once/month; antibodies to natalizumab cause it to stop working; side effects more common in patients positive for neutralizing antibodies
Fingolimod (Gilenya) Misc
Patients must be VZV immune before prescription; oral daily
Dimethyl fumarate (Tecfidera) Misc
Oral BID
Mitoxantrone (Novantrone) Misc
IV; once/3 months
Mycophenolate mofetil (CellCept) Misc
Oral
Methylprednisone (MTP) Misc
Given IV with oral prednisone taper
