Disease modifying therapies can be grouped into three broad types, according to how well they work.
Moderate (work fairly well): [First-line Treatment]
5 different beta interferons : Avonex, Betaferon, Rebif, Extavia, Plegridy Glatiramer acetate (Copaxone) Teriflunomide (Aubagio)
Good (work well): [Second-line Treatment] Dimethyl fumarate (Tecfidera) Fingolimod (Gilenya) Daclizumab (Zinbryta)
High (work very well): [Second-line Treatment] Natalizumab (Tysabri) Alemtuzumab (Lemtrada)
First Line Treatment
Beta Interferons • There are five Beta Interferons. Their brand names are: • Avonex • Betaferon • Extavia • Plegridy • Rebif • Uses: Recent relapses and/or new lesions on MRI scan. Secondary Progressive MS with significant relapses, Clinically Isolated Syndrome. • Effects: Reduce (and might prevent) the inflammation that damages nerves in MS.
Administration of Beta interferons • Avonex injected into muscle once per week. • Betaferon injected under the skin every other day. • Extavia injected under the skin every other day. • Plegridy injected under the skin every two weeks. • Rebif injected under the skin 3 times per week.
Glatiramer acetate (Copaxane) • Uses: Relapsing MS and you’ve had a recent relapse or MRI shows new lesions. Clinically isolated syndrome and a brain scan shows you’re likely to go on to get MS. • Administration: Injection under the skin 3 times per week. • Effects: It’s not clear how glatiramer acetate works, but it seems to kill the immune cells that attack the myelin around your nerves.
Teriflunomide (Aubagio) • Uses: Relapsing MS if you’ve had a recent relapse and/or MRI scans show new lesions. • Effects: It’s not known exactly how it works but it dampens down inflammation. It blocks T Cells so fewer get into your brain and spinal cord and cause inflammation and damage there. • Administration: Tablet once per day.
Second Line Treatment
Dimethyl fumerate (Tecfidera)
Daclizumab (Zinbryta) • This drug is licenced to treat ‘active’ relapsing MS but it’s not yet known for sure who might get this drug. It’s not yet been decided if you can have this as your first DMT or only if another drug has already failed to control your MS. This is because of possible side effects. • NICE and other organisations are now looking at this drug and it may become available in 2017/2018. • Effects: Daclizumab kills T cells, before they get to your brain and spinal cord. This stops them attacking myelin which protects the nerves from inflammation and damage. This drug also rebalances your immune system. • Administration: You inject it under your skin once every 4 weeks.
Natalizumab (Tysabri) • Uses: Relapse in the previous year and MRI scan show as new lesions despite taking another DMT. 2 relapses in the last year and MRI scan shows new lesions whether or not you’ve been taking another DMT. • Effects: Natalizumab kills T cells before they get to the brain and spinal cord and stops them from attacking the myelin around these nerves and causing inflammation and damage. • Administration: It’s given through a drip (‘infusion’) in hospital every 4 weeks. It takes about an hour, with another hour to be monitored.
Alemtuzmab (Lemtrada) • Uses: Can be used as your first DMT if you’ve had a recent relapse and/or MRI shows new lesions. In these cases it can be used whether you’ve tried another DMT or not. • Effects: Kills T and B cells, these cells normally attack viruses and bacteria that get into your body but in MS they attack your nerves by mistake. Alemtuzumab stops them getting into your brain and spinal cord before they damage your nerves there. This drug resets your immune system and changes it for good, which is why you don’t have to keep taking it. • Administration: Infusion in hospital via a drip . Most people need 2 infusions, spaced 12 months apart. The first infusion is given in hospital for 5 days in a row. The infusion takes 4 hours. The second infusion is given a year later, over 3 days in a row. Some people need a 3rd or 4th infusion before the drug works.
New Drugs Ocrelizumab(Ocrevus) • Uses: Not available yet. Trial’s show that it can work for people with ‘active’ relapsing MS but also primary progressive MS. It is not clear yet if the drug will work for all people with primary progressive MS or just some. It can also work if you have secondary progressive MS that doesn’t involve relapses, but it hasn’t been tested against secondary progressive MS that doesn’t involve relapses. It is hoped that it will become available in the UK in 2017 or 2018. • Effects: Ocrelizumab sticks to B cells. This stops them from getting into your brain and spinal cord where they would destroy myelin causing inflammation and damage. • Administration: Drip (‘infusion’) in hospital once every 6 months.
(https://www.mssociety.org.uk/sites/default/files/Disease%20Modifying%20Therapies%20%28DMTs%29%20August%202016a_0.pdf) Accessed 21st Aug 2017
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