Multiple Sclerosis Agents

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Can you name the Multiple Sclerosis Agents?

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Cyclophosphamide class
Methotrexate class
Use: Depression. Also helps with pain
Dose: Oral daily (first PO MS drug)
MOA: Synthetic form of myelin basic PRO copolymer 1. Binds to MHC molecules. Competes w/ myelin antigens for presentation to T cells.
Off line agent used in the treatment of acute attacks
Use: pain and paroxysmal disorders
MOA: Potassium channel blocker. Possibly increases conduction in demyelinated axons
Dose: SC injection 2-3 times weekly
MOA: Purine analog
MOA: alkylating agent
Axathioprine class
Use: Depression. Also helps with fatigue
Fingolimod class
MOA: Antimetabolite and antifolate
Dose: IM weekly
Dose: IV infusion every 3 months
Tricyclic class
Second line agent MOA: monoclonal Ab
Rituximab class
Prednisone class
Mitoxantrone class
Excreted by kidney: contraindicated in moderate to severe renal failure
HintAnswer
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.
Use: For pts who do not respond to corticosteroids during acute attacks
Methylphenidate class
Venlafaxine class
Glatiramer acetate class
MOA: Immunomodulator/antineoplastic
Duloxetine class
Plasmapheresis 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
Tizanidine class
Dalfampridine class
Second line agent: RRMS, SPMS, Progressive Relapsing MS
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/
Mycophenolate class
MOA: Anti-organ rejection drug
MOA: Sphingosine 1-phosphate receptor modulator. Sequesters lymphocytes.
Dose: 1250 mg/day PO for 3-5 days
Bupropion class
IFN beta 1-b (Betaseron) class
SE: Seizures at higher than recommended doses (contraindicated in pts with a hx of seizure)
Baclofen class
Dose: 1 gram/day IV for 3-5 days
IFN beta 1-a (Avonex) class
HintAnswer
Alemtizumab class
Gabapentin class
Second line agent: RRMS. Reduced relapses & progression of disability
Natalizumab 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
Modafinil class
Second line agent given IV monthy
First line RRMS agent injected SC daily
Daclizumab class
Use: Fatigue
Use: treatment of spasticity
IFN beta 1-a (Rebif) class
Methylprednisone class
MOA: Monoclonal Ab. Shows functional improvement not just slowing of decline
Dose: Oral. In extreme cases intrathecal
Carbamazepine class
Dose: SC injection every other day
SE: Thyroid disorders, ITP (with fatal brain hemorrhage), infections.
First line drugs for disease modification
Second line agent for RRMS that produces reduction in progression of disabilty
MOA: Immune modulator, exact mechanism not known.
Use: Fatigue, cognitive impairment (long acting agent)

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