Rochet and Dr.Ott MS drug classes Flashcards
What drugs are used for treatment of acute attacks in MS
Methylprednisolone
Prednisone
Adrenocorticotropic hormone
Explain the benefits of disease modifying therapies in MS
- These can reduce relapse rates and may lead to slower progression oof disability
- Generally used to treat relapsing rather than progressive forms of MS
what are first line drugs used for disease modifying in MS
Interferon B1a (Avonex, Rebif)
Interferon B1b (Betaseron, Extavia)
Glatiramer acetate ( Copaxone)
Fingolimod (gilenya)
what are second line drugs used for disease modifying in MS
Natalizumab (Tysabri)
Mitoxantrone (novantrone)
what are the new drugs used for disease modifying in MS
Teriflunomide (aubagio)
Dimethyl fumarate (Tecfidera)
Cladribine (Mylinax)
Which MS treatments act only in the Periphery
glateramer acetate ( copaxone)
Natalizumab (tysabri) - at BBB
Which MS treatments act only in the CNS
Which MS treatments act in both Periphery and CNS
Fingolimod (gilenya)
Interferons B1a (Avonex, Rebif) and Interferons B1b (betaseron, Extavia) MOA and clinical feature
Work at periphery by blocking the activation of T cells by dendritic cells
Work at BBB by reducing MMP thus inhibiting the penetration of B cells and T cells to the CNS
First line drugs. but their efficacy is reduced by neutralizing antibodies immune response
Can be given SubQ or IM every other day to every 2 weeks
Side effects: flu like symptoms (can avoid by taking NSAID before dose or IM dosing at bedtime) depression, suicidal thinking
Monitor
- LFTs and TSH as these medications can elevate liver function tests and thyroid dysfunction
Glatiramer acetate (copaxone) MOA and clinical features
Works in the periphery
mimics myelin presenting proteins and modulates antigen presenting cells like dendritic cells to decrease T cell activation
Side effects: injection site reaction, post injection reaction (flushing, sweating, chest pain, anxiety, itching)
May be an option for pregnancy if treatment is needed
Fingolimod (Gilenya) MOA and clinical feature - MEM STRUCTURE
Works in CNS to stimulate oligodendrocyte survival and thus promote remyelination
Works in lymph nodes to decrease the release of lymphocytes from the nodes (decrease release of T cells)
MONITOR:
- for 6 hours after first dose due to bradycardia (EKG at baseline)
- Monitor CBC as patient is at increased risk for infection, routine eye exam
Side affects: include progressive multifocal leukoencephalopathy (PML) - this is a potentially lethal brain infection
- discontinuation can result in significant worsening of MS symptoms
CONTRAINDICATED with past arrythmia diagnosis
Natalizumab (Tysabri) MOA and clinical features
- humanized monoclonal antibody that will bind to VLA-4 which is a product of alpha-4 and B 1 integrin binding.
By binding to VLA-4 it blocks binding for T and B cells to bind to alpha-4 and thus interfering with their movement thru BBB and into the CNS
Side effect - can cause PML (lethal brain infection) and can induce development of neutralizing antibodies and cause an allergic reaction
mitoxantrone (Novantrone) MOA
has cytotoxic activity
- works in the peripheral to reduce number of T and B cells by inducing DNA strand breaks and delaying DNA repair by inhibiting Topoisomerase II
Teriflunomide (aubagio)
Cytotoxic agent that inhibits the growth and proliferation of T and B cells
Dimethyl fumarate (tecfidera)
Diroximel fumarate (Vumerity)
Monomethyl fumarate (bafiertam)
MOA and clinical feature
Work in both CNS and Peripheral
- In CNS they stimulate Nrf-2 mediated cellular antioxidant responses and anti-inflammatory pathways
- in Periphery they suppress activated T cells (dendritic cells)
- Capsule should not be opened and sprinkled on food, do not crush or chew
AE: could include PML, Flushing (can take aspirin 30min prior to dose)
