Multiple Sclerosis

Question 1

Which drug can be used in all stages of MS?

Answer 1

Ocrevus

Question 2

What are the 5 interferons, and in which stages are interferons used?

Answer 2

Interferons are indicated for CIS, RRMS and active SPMS disease, and they are:

• Betaseron (SQ)
• Rebif (SQ)
• Avonex (IM)
• Plegridy (SQ)
• Extavia (SQ)

Question 3

Which two DMTs are not used in CIS, due to their side effect profiles?

Answer 3

• Lemtrada
  
  • ​(BBW:fatal AI, IR, stroke, malignancy)
  • REMS med
• Mavenclad (BBW: malignancy, teratogenic)

Question 4

What are the 3 sphingosine 1-phosphate receptor modulators used in CIS, RRMS and/or active SPMS?

Answer 4

• Mayzent
• Gilenya
• Zeposia

Question 5

Which medication is used in chronic SPMS and worsening RRMS?

Answer 5

Novantrone (mitoxantrone), and it has BBWs:

• cardiotoxic, CHF
• LVEF
• secondary AML
• IV by experienced physician only
• BMS (do not give if neutrophils <1500/mm3 (exc. in nonlymphocytic leukemia)

Question 6

Which DMTs are believed to activate the Nrf2 pathway?

Answer 6

• Tecfidera, take with fat/protein
• Vumerity, limit fat/calorie intake, increased risk of HZV and opportunistic infections

both are po bid, have a risk of PML, flushing, NVD, elevated liver enzymes

Question 7

Which DMT inhibits dihydroorotate dehydrogenase and has a BBW for hepatotoxicity and embryolethality?

Answer 7

Aubagio (teroflunamide), and it is contraindicated in hepatic impairment, pregnancy, leflunomide co-administration and hypersensitivity

Question 8

Which 3 DMTs are S1P receptor modulators and what are some unique facts about each?

Answer 8

• Gilenya (1, 3, 4 & 5), increase in disability after stopping, PRES, CI: QTc >500msec, antiarrhythmics
• Zeposia (1 & 5), retitrate if dose is missed in first 2 weeks, CI in sleep apnea
• Mayzent (1 & 5), contraindicated in CYP2C9*3/3 genotype

Question 9

Which 3 DMTs are the same drug that is injected subq, and contraindicated for people with a hypersensivity to mannitol?

Answer 9

• glatiramer acetate
• Glotopa
• Copaxone

Question 10

Which DMT is only available through the TOUCH prescribing program?

Answer 10

Tysabri, binds the a-4b1 and a-4b7 integrins from adhering to the endothelial receptor. 300mg IV over 1 hour every 4 weeks.

Question 11

Which DMTs are administered intravenously?

Answer 11

• Lemtrada (REMS)
• Novantrone
• Ocrevus
• Tysabri (REMS)

Question 12

Which DMT is administered IM?

Answer 12

Avonex

Question 13

Which DMTs are administered subq?

Answer 13

• Betaseron and Extavia
• Copaxone, Glatopa and Glatiramer Acetate
• Plegridy
• Rebif

Question 14

Which DMTs are taken by mouth?

Answer 14

• tabs
  
  • Ampyra-BID
  • Aubagio-QD
  • Mavenclad
  • Mayzent-CYP2C9 dose
• caps
  
  • Gilenya-QD
  • Zeposia-LD, then QD
  • Tecfidera-LD then BID
  • Vumerity-LD then BID

Question 15

Which perenteral DMTs are stable at excursion (15-30ºC or 59-86ºF) and controlled room (20-25ºC or 68-77ºF) temperatures?

Answer 15

• Betaseron and Extavia
• Novantrone

Question 16

Which unopened bottle of tablets needs refrigeration (2-8ºC/36-46ºF) to maintain stability?

Answer 16

Mayzent; once opened, stability is maintained at controlled room temperature (20-25ºC/68-77ºF)

Question 17

Which DMTs need to be handled with gloves?

Answer 17

• Aubagio
• Gilenya
• Mayzent
• Mavenclad needs to be handled with dry hands, but hands and surfaces need to be washed afterwards

Question 18

Which non-DMT has an increased risk of seizures when coadministered with metformin, cimetidine, or other OCT2 inhibitors?

Answer 18

Ampyra