Medication Tables

Injectable Medications

Generic Name Interferon

Beta-1a

Interferon

Beta-1a

Interferon

Beta-1a

Interferon

Beta-1a

Glatiramer

acetate

Glatiramer

acetate

Brand Name Avonex Plegridy Rebif Betaseron Extavia Copaxone Glatopa
How it is given IM SC SC SC SC SC
Frequency Once a week Once every 2 weeks 3 times a week Every other day 3 times a week OR daily Daily
Year of FDA approval 1996 2014 2002 1993 1996 2015
Mechanism Modulates immune system* Modulates immune system* Modulates immune system* Modulates immune system* Modulates immune system* Modulates immune system*
Absolute Reduction in Relapse Rate** 32% 36% 29-32% 31% 33% 33%
Tolerability Flu like sxs, Rare injection site reactions Flu like sxs Possible injection site reactions Flu like sxs Possible injection site reactions Flu like sxs Possible injection site reactions Possible injection site reactions & possible injection reaction (flushing, heart racing) Possible injection site reactions & possible injection reaction (flushing, heart racing)
Safety No consistent adverse events reported No consistent adverse events reported No consistent adverse events reported No consistent adverse events reported No consistent adverse events reported No consistent adverse events reported
Tests required before starting Yes – LFTs, CBC Yes – LFTs. CBC Yes – LFTs, CBC Yes – LFTs, CBC No No
Possible blood tests at your visit LFTs, CBC, TSH LFTs, CBC, TSH LFTs, CBC, TSH LFTs, CBC, TSH None None
Pregnancy Category C C C C B B

Oral Medications

Teriflunomide Fingolimod Dimethyl Fumarate
Brand Name Aubagio Gilenya Tecfidera
Frequency Daily Daily Twice a day
Year FDA Approval 2012 2010 2013
Mechanism Decreases white blood cells Decreases white blood cells in circulation Enhances NRF2 free radical scavenge pathway?
Absolute Reduction in Relapse Rate** 31.5% 52% 44-53%
Tolerability Diarrhea, nausea, hair loss Well tolerated Stomach upset, flushing first month
Safety Potential fetal toxicity, Rare liver function abnormalities First dose heart slowing, macular edema, PML reported No significant adverse events in trial, PML reported
Tests required before starting Yes – T Spot for TB, LFTs Yes – Eye exam and EKG, VZV antibody titer Yes- LFTs, CBC, lymphocyte count
Possible blood tests at your visit LFTs LFTs,  CBC, lymphocyte count LFTs, CBC, lymphocyte count
Pregnancy Category X C C

Infusion Medications

Natalizumab Rituximab Ocrelizumab Alemtuzumab
Brand Name Tysabri Rituxan Ocrevus  Lemtrada
Frequency Once a month Once every 6 months Once every 6 months Once every few years
Year FDA Approval 2004 1997 (not FDA approved for MS) Not yet approved 2014
Mechanism Prevents lymphocyte trafficking across BBB Depletes CD20+ B cells Depletes CD20+ B cells Anti CD52–> lymphocyte destruction
Absolute Reduction in Relapse Rate** 68% 58% 47% (vs. IFN) 49.4-54.9%
Tolerability Possible allergic reaction, during infusion Possible infusion reaction Possible infusion reaction Possible infusion reaction
Safety PML risk Possible serious infection/ possible PML, though never reported in MS pts No opportunistic infections reported in trials with MS patients Infusion reactions, thyroid disease, ITP, Goodpasture’s
Tests required before starting Yes- JCV Ab titer Yes- Hepatitis Panel, CMP, CBC, HIV, RPR, T-spot, SPEP Yes- Hepatitis Panel, CMP, CBC, HIV, RPR, T-spot, SPEP Yes – TSH, CMP, CBC, VZV antibody titer
Possible blood tests at your visit JCV Ab titer (checked every 6 months) CD19/CD20 CD19/CD20 TSH, CMP, CBC, UA
Pregnancy Category C C Not yet assigned C

 

IM = Intramuscular injection; SC = Subcutaneous injection;  LFTs = liver function tests; CBC = Complete Blood Count; WBC = White Blood Cell Count;  CMP = complete metabolic panel; TSH = Thyroid stimulating hormone; UA = Urinalysis; sxs = symptoms

* See webpage for more detail on mechanism of action  **Based on Phase II/III clinical trials