Multiple Sclerosis (MS) Medications (cont.)
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
In this Article
- Introduction to drugs for the treatment of multiple sclerosis
- What are steroids, and which ones are available?
- What are disease modifying drugs, and which ones are available?
- Avonex (interferon beta-1a)
- Rebif (interferon beta-1a)
- Betaseron and Extavia (interferon beta-1b)
- Copaxone (glatiramer acetate)
- Novantrone (mitoxantrone)
- Tysabri (natalizumab)
- Aubagio (teriflunomide)
- Gilenya (fingolimod)
- Lemtrada (alemtuzumab)
- Plegridy (peginterferon beta-1a)
- Tecfidera (dimethyl fumarate or DMF)
- Ampyra (dalfampridine)
What are disease modifying drugs, and which ones are available?
Disease modifying drugs (DMDs) can decrease the frequency and severity of acute attacks, delay the progression of MS, and slow down the progression of disease related disability and cognitive decline. DMDs are most effective when started early in the course of the disease.
Interferon beta-1a, the active chemical in Avonex and Rebif, is a naturally occurring protein found in the body. Avonex and Rebif are synthesized using recombinant DNA technology, and the synthetic chemicals are identical to the natural protein. Although the mechanism of action of interferon beta-1a in MS is unknown, interferon beta-1a is thought to inhibit the expression of chemicals that trigger the autoimmune response which causes inflammation and neurodegeneration associated with MS. Avonex and Rebif are used for the treatment of patients with relapsing forms of MS to slow the progression of physical disability and decrease the frequency of flare ups. Interferons, type beta-1a and 1b, are associated with significant side effects. The most common side effects are injection site reactions. Flu-like symptoms are also common but can be managed with acetaminophen (Tylenol), ibuprofen (Motrin), and glucocorticoids. Additionally, interferons may cause liver damage and depression. Depression and flu-like symptoms are transient and usually decrease or go away with time.
Avonex (interferon beta-1a)
Avonex is administered by intramuscular injection once a week. Once weekly Avonex is preferred over Rebif (administered 3 times weekly) by some patients because of fewer injections and injection-site reactions. In clinical studies disease progression was slower in Avonex treated patients. Compared to patients treated with placebo, the risk of progressive physical disability was reduced by 37% in patients treated with Avonex. Side effects associated with Avonex include flu-like symptoms, depression, abnormal liver tests, and a drop in red and white blood cells and platelets. Allergic reactions, seizures, and heart failure also have been associated with Avonex. Due to the risk of miscarriage or harm to fetus, Avonex should only be used during pregnancy if the potential benefit justifies the potential harm to the fetus. Females of reproductive potential should be made aware of the risk and use appropriate birth control while receiving treatment. Avonex is classified FDA pregnancy risk category C.
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