Drug | Mechanism of Action | Approved Indication | Usual Dosage | Notes |
---|---|---|---|---|
Interferon beta-1a (Avonex®) | Anti-proliferation, immunomodulation | RRMS | 30 mcg SC once weekly | |
Interferon beta- 1a (Rebif®) | Anti-proliferation, immunomodulation | RRMS | 20% of target dose initially, titrate to 22 mcg or 44 mcg IM TIW over 4 weeks | Administer on the same days each week, at least 48 hours apart |
Interferon beta-1b (Betaseron®) | Anti-proliferation, immunomodulation | RRMS, CIS with MRI features consistent with MS | 0.0625 mg SC QOD initially; increase to 0.25 mg QOD over 6 weeks | CBC and LFT at baseline and 1,3,6 months thereafter; TFT every 6 months in selected patients |
Glatiramer (Copaxone®) | Competitive binding with MBP, cytokine modulation & inhibition of free radical | RRMS | 20 mg SC daily | Routine laboratory monitoring is not required |
Mitoxantrone (Novantrone®) | Intercalates into DNA; interferes with RNA; inhibits topoisomerase II; anti-proliferation; immunomodulation; TNF-α and IL-2 inhibition | SPMS, PRMS, or worsening RRMS | 12mg/m2 IV infusion over 5-15 minutes every 3 months | Bone marrow suppression (neuropenia) may occur. CBC should be monitored prior to initial dose, before each subsequent dose, and after discontinuation of therapy Assessment of cardiac function recommended prior to initiation, during treatment and yearly after discontinuation (history, physical examination, electrocardiogram and quantitative evaluation of left ventricular ejection fraction via echocardiogram, multi-gated radionuclide angiography (MUGA), MRI, etc.) LFT should be monitored prior to initial dose and before each subsequent dose Secondary acute myelogenous leukemia (AML) has been reported. Elevated risk of 0.25% has been observed |
Natalizumab (Tysabri®) | Inhibits the adhesion of molecules onto the surface of immune cells; potentially inhibits the migration of immune cells | Monotherapy for relapsing forms of MS | 300mg IV infusion over approximately one hour every 4 weeks (data on the efficacy and safety is limited to two years) | CBC, WBC, LFT (including bilirubin) should be monitored regularly Antibody testing upon initiation and at 3 months (if persistent antibodies are suspected) Hypersensitivity/ anaphylaxis may occur within 2 hours of infusion Gadolinium-enhanced brain MRI and CSF analysis for JC viral DNA are recommended for suspected PML |