Drugs Used for Treating Multiple Sclerosis (cont.)

Copaxone (glatiramer acetate)

Copaxone is used for reducing the frequency of acute flare ups in patients with Relapsing-Remitting Multiple Sclerosis (RRMS). Copaxone is a synthetic protein that modifies the immune reactions that may be responsible for MS, but its exact mechanism of action is unknown. Copaxone is administered subcutaneously once daily. In clinical trials Copaxone reduced the frequency of relapses and damage to nerves in patients with RRMS. Side effects associated with Copaxone include injection site pain, redness, itching, or lump; nausea and vomiting; infection and influenza-like symptoms. Some patients report flushing, chest tightness or pain, heart palpitations, anxiety, and trouble breathing after an injection of Copaxone. These symptoms generally appear within minutes after an injection, last a few minutes, and then subside.

Novantrone (mitoxantrone)

Novantrone is used for reducing neurologic disability and the frequency of acute flare ups in patients with secondary (chronic) progressive, progressive relapsing, or worsening relapsing-remitting MS. Novantrone is not used for the treatment of patients with primary progressive multiple sclerosis. Novantrone is a synthetic (man-made) injectable drug that interacts with deoxyribonucleic acid (DNA) It interferes with immune reactions by inhibiting the proliferation of B cells, T cells, and macrophages, all important cells of the immune reaction.. It also impairs the presentation of antigens to cells of the immune system and the secretion of interferon gamma, TNFa, and IL-2, chemicals that promote inflammation. The mechanism of action of Novantrone in MS is not known but may be related to its modification of the immune system as discussed. In clinical trials, Novantrone improved disability, ambulation, frequency of relapse, and neurologic status better than placebo. Novantrone is administered as an intravenous infusion every 3 months. Novantrone can damage the heart. Therefore, patients with left ventricular ejection fraction (LVEF) <50%, clinically significant reduction in LVEF, or those who have received a cumulative lifetime dose of Novantrone of 140 mg/m2 should not receive Novantrone. Novantrone should not be administered to patients with white blood cell counts less than 1500 cells/mm3, abnormal liver tests, or who are pregnant. Adverse effects include nausea, hair thinning, loss of menstrual periods, bladder infections, and mouth sores. Heart failure, reduced white blood cell or platelet count may occur. Reduced white blood cell counts may lead to infections, and reduced platelets may lead to bleeding. Novantrone is dark blue in color, so it may turn urine or the sclera of the eyes blue-green.

REFERENCES:

Prescribing Information for Avonex (interferon beta-1a); Betaseron (interferon beta-1b); Copaxone (glatiramer acetate); Rebif (interferon beta-1a); Novantrone (mitoxantrone); Tysabri (natalizumab); AMPYRA (dalfampridine)

Litzinger MH, Litzinger M. Multiple Sclerosis: A therapeutic overview. US Pharmacist 2009;34(1):HS3-HS9