Neurology
Information, Symptoms, Treatments and Resources
Information contained in this healthpage is from this publication: www.nationalmssociety.org/download.aspx?id=45, “The MS Disease Modifying” Drugs dated October 30, 2009.
The Disease Modifying Drugs
commonly referred to as DMDs or CRABs
The FDA approved new oral disease modifying therapy which is not included in this write-up at this time
Options
There are currently seven disease-modifying medications approved by the U.S. Food and Drug Administration (FDA) for use in relapsing forms of MS (including secondary progressive MS for those people who are still experiencing relapses). They may work differently for everyone and none of them are a cure for MS. None will prevent recurring symptoms, such as fatigue or numbness, which typically come and go. All of them have proven records of partial to substantial success. Unfortunately, none of the currently available disease-modifying drugs are approved for treating primary progressive MS — the type of MS that shows steady progression at onset.
Decisions about taking a disease-modifying drug are best made by carefully considering and weighing factors including individual lifestyles, known side effects, and the potential risks and benefits of the different therapies. A full discussion with a knowledgeable healthcare professional is the best
guide for your decision. Each person’s body or disease can respond to these medications in different ways.
The following charts sort out and present some of the relevant facts. Rebif®, Copaxone®, Betaseron®, Extavia® and Avonex® are self-injectable drugs for long-term use; they modulate the immune system, which means they adjust or modify how the immune system functions. Tysabri®, which is also an immune-modulating drug, is delivered by IV infusion (into the vein) at a registered infusion facility. Novantrone® is a powerful immune system suppressor, delivered by IV infusion in a medical setting.
Benefits of the Disease-Modifying Drugs
Reducing the frequency and severity of attacks
Most people using a disease-modifying drug have fewer
and less severe MS attacks (relapses or exacerbations). In
individual clinical trials comparing a drug versus an inactive
placebo treatment, MS attacks were reduced by 28–68
percent by different agents. In addition, most people were
found to have fewer, smaller, or no new lesions developing
within their central nervous system as visible in MRI scans.
Preventing permanent damage
Permanent damage to nerve fibers (called axons) occurs
early in MS in association with the destruction of myelin.
Overall brain shrinkage (or atrophy), can occur early in the
disease, and damage can be ongoing even when the person
has no symptoms of an attack and feels well. Therefore,
MS specialists advise the early use of a drug that effectively
limits lesion formation and brain atrophy, or shrinkage. In
the opinion of the National MS Society’s Clinical Advisory
Board, limiting lesions may be a key to reducing future
permanent disability for many people with MS.
Indications:
Copaxone Rebif Avonex Extavia Betaseron Novantrone Tysabri For the treatment of relapsing-remitting MS ; and for patients who have experienced a first clinical episode and have MRI features consistent with MS . For the treatment of relapsing forms of MS. For the treatment of relapsing forms of MS, and for a first clinical episode if MRI features consistent with MS are also present. Extavia For the treatment of relapsing forms of MS and secondary progressive MS with relapses; and for patients who have experienced a first clinical episode and have MRI features. For the treatment of relapsing forms of MS and secondary progressive MS with relapses; and for patients who have experienced a first clinical episode and have MRI features consistent with MS . Four times a year by IV infusion in a medical facility. Lifetime cumulative dose limit of approximately 8–12 doses over 2–3 years (140 mg/m2). For the treatment of relapsing forms of MS as a monotherapy (not used in combination with any other disease-modifying medication). Generally recommended for patients who have had inadequate response to, or are unable to tolerate, another disease modifying medication.
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Common Side Effects
(Always inform your healthcare professional of side effects)
Immunomodulating drugs
Avonex®
Flu-like symptoms following injection, which lessen over time
for many. (See “Managing side effects” on page 9.) Less common:
depression, mild anemia, liver abnormalities*, allergic reactions,
heart problems.
Betaseron®
Flu-like symptoms following injection, which lessen over time for
many. (See “Managing side effects on page 9.) Injection site
reactions, about 5% of which need medical attention. Less
common: allergic reactions, depression, liver abnormalities*,
low white blood cell counts.
Copaxone®
Injection site reactions. Less common: vasodilation (dilation of
blood vessels); chest pain; a reaction immediately after injection,
which includes anxiety, chest pain, palpitations, shortness of
breath, and flushing. This lasts 15-30 minutes, passes without
treatment, and has no known long-term effects.
Extavia®
Flu-like symptoms following injection, which lessen over time
for many. (See “Managing side effects” on page 9.) Injection site
reactions, about 5% of which need medical attention. Less
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