Know Your Therapy Choices and Risks

The battle against multiple sclerosis has advanced considerably in recent years. A number of drugs are effective in alleviating symptoms and helping combat relapses. However, as with any disease, it's crucial to understand the benefits and risks of specific treatment options and choose the right therapy. Not taking any action is riskier.

Avonex (interferon beta-1a)

Company: Biogen Idec

Description: Avonex treats relapsing MS. Avonex is an interferon. Interferons are messengers produced by the body to modulate the immune response. Avonex prevents the immune system from attacking the central nervous system, reducing the number and severity of exacerbations.

Treatment: Intramuscular injection (into the muscle) once a week.

Side effects: Flu-like symptoms that typically lesson over time. Less common: depression, mild anemia, liver abnormalities, allergic reactions, heart problems.

Results: Avonex, first approved in 1996, has proven to be both safe and effective in reducing the progression of physical disability due to Multiple Sclerosis, reducing the occurrence of relapses and reducing the number of lesions appearing on follow-up MRI's. Further studies in Relapsing-remitting MS have shown a significant reduction in number of patients who have progressed to an EDSS disability score above the 6.0 mark.

Betaseron (interferon beta-1b)

Company: Bayer HealthCare Pharmaceuticals

Description: Betaseron is an interferon. Modulating the immune response in the central nervous system it reduces inflammation, along with the number and severity of exacerbations. It also stabilizes the lesion area.

Treatment: Subcutaneous injection (under the skin) injection every other day.

Side effects: Flu-like symptoms that typically lesson over time. Injection site reactions. Less common: depression, liver abnormalities, allergic reactions, low white blood cell count.

Results: Betaseron was approved in 1993 and works by reducing the body's immune response that attacks nerve cells. The drug is made from human blood plasma; interferon beta is a protein that's normally manufactured by the body. The drug has demonstrated a long history of success. One trial found that the drug reduces the onset of MS by 50 percent in the first two years for patients that display Clinically Isolated Syndrome (CIS).

Copaxone (glatiramer acetate)

Company: Teva Neuroscience

Description: Mimics myelin protein and thereby decreases T cell production. This results in reduced inflammation. Copaxone may also stimulate cellular activity that prevents damage to nerve fibers.

Treatment: Subcutaneous injection every day.

Side effects: Injection site reactions, dilation of blood vessels, chest pain, post-injection reaction consisting of anxiety, chest pain, heart palpitations, flushing and shortness of breath lasting up to 30 minutes.

Results: The synthetic polypeptide, approved in 1996, has a consistent track record of improving immune system function and reducing exacerbations. Only one-third of patients who take the drug experience a progression of MS. In addition, 57 percent have achieved stable or improved EDSS scores. Copaxone is the only RRMS therapy that doesn't require routine monitoring.

Extavia (interferon beta-1b)

Company: Novartis Pharmaceutical

Description: Extavia, which is identical to Betaseron, reduces inflammation and the frequency and severity of attacks.

Treatment: See Betaseron.

Side effects: See Betaseron.

Results: See Betaseron.

Gilenya (fingolimod, FTY720)

Company: Novartis Pharmaceutical

Description: Gilenya, referred to as an S1P-receptor modulator, mimics the structure of naturally occurring cell surface receptors and thus blocks destructive T cells from leaving the lymph nodes.

Treatment: Capsule taken orally every day.

Side effects: Headache, flu-like symptoms, diarrhea, back pain, liver enzyme elevations and cough. Less common: slowed heart rate following the first dose, infections, eye swelling.

Results: The drug, approved by the FDA in November 2010, is the first in a new class of immunomodulatory therapies that, by acting in a similar way to white blood cells, reduce damage to the central nervous system and enhance the repair of damaged neurons. Gilenya has demonstrated the ability to reduce relapse rates by 60 percent and reduce the progression of MS by up to 82 percent when measured with an MRI.

Novantrone (mitoxantrone)

Company: EMD Serono

Description: Novantrone, an immunosuppressant that is also used to treat cancer, aids those with progressive-relapsing MS (PRMS) and others not responding to standard therapies. The drug decreases lesions and stabilizes MS in some patients.

Treatment: IV infusion in a medical facility four times a year. Lifetime dosage limit typically between 8-12 doses over 2-3 years.

Side effects: Discolored urine following administration, infections, bone marrow suppression, nausea, hair thinning, bladder infections, mouth sores. It's also necessary to monitor the use of the drug for serious liver and heart damage, cardiac disease and leukemia.

Results: The drug works by suppressing the immune system and lessens inflammation of the myelin sheath that surrounds nerves. It is used for relapsing-remitting, progressive-relapsing, and secondary-progressive forms of MS. The drug, approved in 2000, has a track record of improving EDSS scores and reducing relapses. In one clinical trial, 90 percent of patients taking the drug in combination with methylprednisolone were without lesions after six months.

Rebif (interferon beta-1a)

Companies: EMD Serono and Pfizer.

Description: Approved for relapsing types of MS. Rebif relies on interferons, which simulate naturally occurring proteins, to reduce inflammation by better modulating the immune system.

Treatment: Subcutaneous injection three times per week.

Side effects: Flu-like symptoms that frequently lesson over time, injection site reactions. Less common: liver abnormalities, depression, allergic reactions, low white blood cell count.

Results: The drug, which has more than 17 years of clinical trial and patient use, is designed for those with RRMS. Patients who took the drug for two years showed a 78 percent reduction in lesions, a reduced need for steroid treatments and fewer exacerbations. Rebif new formulation (RNF) is not yet approved in the U.S. but trials show that it reduces side effects and further reduces lesions.

Tysabri (natalizumab)

Companies: Biogen Idec and Elan Pharmaceuticals

Description: Tysabri is approved for relapsing types of MS. Generally used for patients that have seen no improvement with other MS treatments. Relies on a monoclonal antibody which inhibits lymphocytes that attack the central nervous system.

Treatment: IV infusion in a medical facility every four weeks.

Side effects: Headache, fatigue, depression, urinary tract infections, lower respiratory tract infections, joint pain, and chest discomfort. Less common: allergic or hypersensitive reactions after infusion (fever, rash, dizziness, nausea, flushing, low blood pressure, breathing difficulties, chest pains). It's also critical to test for PML, a rare but often-fatal brain disease caused by the JC virus. For this reason, patients who receive Tysabri should participate in safety monitoring programs at registered infusion centers so that it's possible to watch for adverse events and provide immediate treatment, if needed.

Results: Studies show that Tysabri, FDA approved in 2005. can repair damage to the myelin sheath, slow progression of disability and help reduce relapses. It is also effective in reducing fatigue and improving language processing, cognitive function and vision loss related to RRMS. 87 percent of RRMS patients (previously treated with other therapies) who took Tysabri showed stable or improved MRI scans after 18 to 24 months. EDSS scores were stable or improved in 59 percent of patients.