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©The Author(s) 2015.
World J Clin Cases. Jul 16, 2015; 3(7): 545-555
Published online Jul 16, 2015. doi: 10.12998/wjcc.v3.i7.545
Published online Jul 16, 2015. doi: 10.12998/wjcc.v3.i7.545
Table 1 Main characteristics of available disease-modifying therapies for multiple sclerosis
Agent | Indication and line of therapy | Dosage, route and frequency | Clinical efficacy in placebo-controlled phase III trials | Tolerability issues | Safety issues |
Interferon beta 1b | RR MS; SP MS with relapses; CIS First line | 250 mcg s.c. every other day | 34% reduction of ARR over two years (RR MS) 50% risk reduction of conversion to CD MS at two years (CIS) No statistically significant effect on disability progression | Flu-like syndrome; injection site reactions | Hepatotoxicity; myelotoxicity; autoimmune thyroiditis; microangiopathy; epileptic seizures (rare) |
Interferon beta 1a | RR MS; CIS First line | 30 mcg i.m. once a week | 18% reduction of ARR over two years (RR MS) 44% risk reduction of conversion to CD MS at two years (CIS) No statistically significant effect on disability progression | Same as above | Same as above |
Interferon beta 1a | RR MS; CIS First line | 44 mcg s.c. three times a week | 32% reduction of ARR over two years (RR MS) 45% risk reduction of conversion to CD MS at two years (CIS) 30% reduction of progression of disability at two years (RR MS) | Same as above | Same as above |
Peginterferon beta 1a | RR MS First line | 125 mcg s.c. every two weeks | 36% reduction of ARR over one year | Same as above | Same as above |
Glatiramer acetate | RR MS; CIS First line | 20 mg s.c. every day | 29% reduction of ARR over two years (RRMS) 45% risk reduction of conversion to CDMS at three years (CIS) No statistically significant effect on disability progression | Injection site reactions; post-injection reaction (chest pain, flushing and dyspnea) | Cutaneous necrosis; anaphylaxis (rare) |
Mitoxantrone | RR MS; SP MS; PR MS Second or third line | 12 mg/m2i.v. every three months or 8 mg/m2i.v. every month | 65% reduction of relapse risk over two years (mostly in RR MS)[98] 66% reduction of risk of disability progression at two years (mostly in RR MS)[98] | Nausea/vomiting; amenorrhea/infertility; alopecia; blue discoloration of sclera and urine | Infusion site tissue necrosis; myelotoxicity; infections; cardiotoxicity; acute leukemia |
Natalizumab | RR MS Second line | 300 mg i.v. every four weeks | 68% reduction of ARR over two years 42% reduction of progression of disability at two years | Headache | Infusion associated reactions; anaphylaxis; infections; hepatotoxicity; progressive multifocal leukoencephalopathy |
Fingolimod | RR MS Second line (first line in the United States) | 0.5 mg per os every day | 48%-54% reduction of ARR over two years 30% reduction of progression of disability at two years | Fatigue; headache | Bradyarrhythmias after first dose; lymphopenia; viral infections (VZV); macular edema; hepatotoxicity; hypertension |
Teriflunomide | RR MS First line | 14 mg per os every day | 31%-36% reduction of ARR over one year or more 26%-32% reduction of progression of disability at one year or more | Nausea; diarrhea; alopecia | Myelotoxicity; hepatotoxicity; infections; peripheral neuropathy; pancreatic fibrosis; teratogenicity (requires accelerated elimination procedure) |
Dimethyl fumarate | RR MS First line | 240 mg per os twice a day | 44%-53% reduction of ARR over two years 38% reduction of progression of disability at two years | Flushing; gastrointestinal symptoms; pruritus | Lymphopenia; progressive multifocal leukoencephalopathy |
Alemtuzumab | RR MS Second or third line | 12 mg/d i.v. for five days followed by 12 mg/d i.v. for three days one year after the first course | 49%-55% reduction of ARR over two years compared to s.c. interferon beta 1a 42% reduction of progression of disability at two years compared to s.c. interferon beta 1a | Infusion associated reactions; myalgia; arthralgia; irregular menstruation | Infusion associated reactions; cytokine release syndrome; lymphopenia; infections; autoimmune thyroiditis; thrombocytopenic purpura; glomerulonephritis |
Azathioprine1 | MS of all types First or second line | 2.5 mg/kg per os every day | 23% relative risk reduction of the frequency of relapses over two years No statistically significant effect on disability progression at two and three years[98] | Gastrointestinal symptoms; photosensitivity; irregular menstruation/reduced fertility | Myelotoxicity; hepatotoxicity; lymphopenia; infections; acute pancreatitis; increased toxicity in subjects with thiopurine methyltransferase deficiency; malignancies (cumulative dose > 600 g) |
Cyclophos- phamide1 | SP MS; PP MS Third line | 1 g i.v. over three days or 500 mg i.v. over five days | No statistically significant effect on disability progression at two and three years[98] | Nausea/vomiting; amenorrhea/infertility; alopecia | Myelotoxicity; hepatotoxicity; infections; hemorrhagic cystitis; bladder cancer |
- Citation: Gajofatto A, Benedetti MD. Treatment strategies for multiple sclerosis: When to start, when to change, when to stop? World J Clin Cases 2015; 3(7): 545-555
- URL: https://www.wjgnet.com/2307-8960/full/v3/i7/545.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v3.i7.545