Table 1: FDA Approved Disease-Modifying Agents for the Management of Multiple Sclerosis

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

MBP = myelin binding proteins; TNF = tumor necrosis factor; IL = interleukin; CIS = clinical isolated syndrome; RRMS = relapsing-remitting multiple scleroris; MRI = magnetic resonance imaging; SPMS = secondary progressive multiple sclerosis; PRMS = progressive relapsing multiple sclerosis; SC = subcutaneously; QOD = every other day; IV = intravenously; CBC = complete blood count; LFT = liver function tests; TFT = thyroid function tests; CSF = cerebrospinal fluid; PML = progressive multifocal leukoencephalopathy.