Multiple Sclerosis Disease Modifying Drugs

Multiple sclerosis is an autoimmune condition in which the immune system disrupts the myelin sheaths of nerve cells. This results in neurologic dysfunction including motor and sensory deficits including vision changes (internuclear ophthalmoplegia), gait instability, and weakness.  Pain, fatigue, and cognitive changes are also common symptoms.  Mainstay of treatment is focused on reducing inflammation caused by the immune response. 

Multiple sclerosis is more predominant in women (3:1) compared to men.  MS affects all races, but European descent is a risk factor. 

Corticosteroids reduce inflammation generally and are used in the treatment of multiple sclerosis during flares of illness.  Corticosteroids are covered in an alternate chapter.  

Class Drugs

• Interferon B1a & Interferon B1b

• Glatiramer

• Fingolimod

• Teriflunomide

• Dimethyl fumarate

• Natalizumab

• Mitoxantrone

Class Mechanism of Action

• See each drug.

Class Application

• Multiple Sclerosis

Class Adverse Effects

• See each drug.

Drug Table

Drug Name	Application	Comments	Image
Interferon B1a; Interferon B1b	Multiple Sclerosis	Mechanism; Reduces inflammatory response, thereby reducing destruction of myelin sheath of axons; Adverse Effects; -Depression; -Influenza-like illness; -Elevated liver enzymes	"Interfering B"
Glatiramer	Multiple Sclerosis	Mechanism; Sacrificial synthetic protein that attracts attack from T-cells (rather than myelin on axon sheath); Adverse Effects; Injected medication that can cause a generally self-limited post-injection reaction:; -Chest pain; -Flushing; -Itching	"Galactic Mirror"
Fingolimod	Multiple Sclerosis	Mechanism; -Reduces CNS lymphocytes by slowing lymphocyte migration; Adverse Effects; -Bradycardia; -Increased risk of infection; -Macular edema	"Finger" "Limo"
Teriflunomide	Multiple Sclerosis	Mechanism; -Pyrimidine synthesis inhibitor; -Reduces CNS lymphocytes; Adverse Effects; -Elevated liver enzymes	"Terrible Flu" "Nomad"
Dimethyl Fumarate	Multiple Sclerosis	Mechanism; Alters cellular response to oxidative stress; Adverse Effects; -Flushing; -Abdominal pain	"Dime" "Ethyl" "Fuming"
Natalizumab	Multiple Sclerosis; Crohn's Disease	Mechanism; -Monoclonal antibody treatment; -Targets alpha-4 integrin; -Limits WBC ability to enter CNS, which reduces inflammation; Adverse Effects; Linked to development of PML (progressive multifocal leukoencephalopathy) from JC virus	"Natalie" wearing "Zumbaz"
Mitoxantrone	Multiple Sclerosis	Mechanism; Anthracycline analog that kills T-cells	"Mitochondria" "Ant" "Drone"