Miscellaneous / Multiple Sclerosis Agents

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Can you name the Multiple Sclerosis Agents?

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Second line agent: RRMS. Reduced relapses & progression of disability
Venlafaxine class
Daclizumab class
SE: Localized inj site reactions. Self-limited (15-20 min) acute rxn resembling a panic attack (palpitations, dyspnea, flushing) -- not an indication to stop tx
SE: Seizures at higher than recommended doses (contraindicated in pts with a hx of seizure)
Mycophenolate class
Methotrexate class
Second line agent given IV monthy
Use: Depression. Also helps with pain
Gabapentin class
Tizanidine class
SE: Thyroid disorders, ITP (with fatal brain hemorrhage), infections.
Excreted by kidney: contraindicated in moderate to severe renal failure
Dalfampridine class
Carbamazepine class
MOA: Monoclonal Ab. Shows functional improvement not just slowing of decline
Dose: IM weekly
Use: For pts who do not respond to corticosteroids during acute attacks
Dose: Oral daily (first PO MS drug)
Dose: SC injection every other day
Plasmapheresis class
Baclofen class
Rituximab class
Dose: 1 gram/day IV for 3-5 days
Methylphenidate class
MOA: Immunomodulator/antineoplastic
Use: Fatigue, cognitive impairment (long acting agent)
First line RRMS agent injected SC daily
Prednisone class
MOA: Sphingosine 1-phosphate receptor modulator. Sequesters lymphocytes.
Second line agent: RRMS, SPMS, Progressive Relapsing MS
MOA: Potassium channel blocker. Possibly increases conduction in demyelinated axons
Use: Fatigue
Second line agent for RRMS that produces reduction in progression of disabilty
Natalizumab class
Cyclophosphamide class
MOA: Anti-organ rejection drug
Duloxetine class
MOA: Synthetic form of myelin basic PRO copolymer 1. Binds to MHC molecules. Competes w/ myelin antigens for presentation to T cells.
Use: pain and paroxysmal disorders
MOA: Antimetabolite and antifolate
MOA: alkylating agent
IFN beta 1-a (Rebif) class
Second line agent MOA: monoclonal Ab
Fingolimod class
Tricyclic class
SE: Inj site rxn w/ high doses, flu-like s/s (responds well to naproxen), monitor liver fx, may develop neutralizing Ab, may increase depression.
MOA: Purine analog
SE: Risk of progressive multifocal leukoencephalopathy. Rare fatal viral (polymyxoma JC virus) reactivation infxn affecting white matter in immunosuppressed (only a risk to pts w/
Methylprednisone class
Bupropion class
SE: HR reduction of 10-20 bpm, occasionally bradyarrhythmias or AV block -- screen for cardiac dz (6 hr monitoring w/ first dose). Macular edema in 1% (reversible). Check varicella
Use: Depression. Also helps with fatigue
First line drugs for disease modification
Modafinil class
Off line agent used in the treatment of acute attacks
Dose: SC injection 2-3 times weekly
Mitoxantrone class
Glatiramer acetate class
Use: treatment of spasticity
IFN beta 1-a (Avonex) class
MOA: Immune modulator, exact mechanism not known.
Axathioprine class
Dose: 1250 mg/day PO for 3-5 days
IFN beta 1-b (Betaseron) class
Dose: Oral. In extreme cases intrathecal
Alemtizumab class
Dose: IV infusion every 3 months

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