Multiple Sclerosis Treatment Options Table

MS Disease-Modifying Therapies

What the medication
is used for

Teriflunomide (Aubagio®)

(Oral film-coated tablets)

How it works:
The exact mechanism is not clear. It may work by altering the way the body's immune system works

Place in therapy:
Use as a single agent for the treatment of relapsing-remitting multiple sclerosis to reduce the frequency of attacks, and to delay the accumulation of physical symptoms

Interferon Beta 1-A (Avonex®)

(Intra-muscular injection in prefilled syringes and in prefilled autoinjectors)

How it works:
It may modify the immune system response but the exact way it works in MS is unknown

Place in therapy:
Treatment of relapsing forms of multiple sclerosis to slow the progression of physical symptoms and to decrease the frequency of relapses and the number and volume of active brain lesions

Treatment of a single episode accompanied by abnormal MRI scans to delay the onset of clinically definite multiple sclerosis and to decrease the number and volume of active brain lesions and the overall disease burden

Treatment of secondary-progressive multiple sclerosis to decrease brain lesions as shown on MRI and to reduce the frequency of relapses

Interferon Beta 1-B (Betaseron®)

(Powder for subcutaneous injection 0.3 mg/vial)

How it works:
It may modify the immune system response but the exact way it works in MS is unknown

Place in therapy:
Treatment of a single episode accompanied by abnormal MRI scans to delay the progression to definite multiple sclerosis

Treatment of relapsing-remitting multiple sclerosis to reduce the frequency of relapses

Treatment of secondary-progressive multiple sclerosis to slow progression of physical symptoms and reduce the frequency of relapses

Glatiramer acetate (Copaxone®)

(20 mg/1 mL prefilled syringes for subcutaneous injection)

How it works:
Modifies the immune system processes thought to be involved in MS but the exact way it works is unknown

Place in therapy:
Treatment of relapsing remitting multiple sclerosis to decrease the frequency of relapses and to reduce active brain lesions as seen on MRI scans

Treatment of a single clinical attack accompanied by abnormal MRI scans to delay the onset of definite multiple sclerosis and decrease active brain lesions and overall disease burden (as seen on MRI scans)

Interferon Beta 1-B (Extavia®)

(Powder for subcutaneous injection 0.3 mg/vial)

How it works:
It may modify the immune system response but the exact way it works in MS is unknown

Place in therapy:
Treatment of a single episode accompanied by abnormal MRI scans to delay progression to definite multiple sclerosis

Treatment of relapsing-remitting multiple sclerosis to reduce the frequency of relapses

Treatment of secondary-progressive multiple sclerosis to slow progression of physical symptoms and to reduce the frequency of relapses

Fingolimod (Gilenya®)

(Oral capsules)

How it works:
The exact way it works in MS is unknown, however it is speculated that the drug affects the ability of some white blood cells to move freely within the body and prevents cells that cause inflammation from reaching the brain. This reduces the nerve damage caused by MS.

Place in therapy:
Use as a single agent for treatment of relapsing-remitting form of multiple sclerosis to reduce the frequency of relapses and to delay progression of physical symptoms

This medication is generally used in patients who have had an inadequate response to, or are unable to tolerate other therapies for multiple sclerosis

Alemtuzumab (Lemtrada®)

(12 mg/1.2 mL solution for IV infusion)

How it works:
Reduces the immune system's attack on the nervous system, but the exact way it works in MS is not known

Place in therapy:
Management of relapsing remitting multiple sclerosis with active disease defined by clinical features and imaging, where there has been an inadequate response to other disease-modifying therapies for multiple sclerosis (e.g. interferon beta)

Interferon Beta 1-A (Rebif®)

(Solution for injection in pre-filled syringes, pre-filled cartridges, and pre-filled pens)

How it works:
It may modify the immune system response but the exact way it works in MS is unknown

Place in therapy:
Treatment of relapsing forms of multiple sclerosis, to reduce the number and severity of relapses, slow the progression of physical symptoms, reduce the requirement for steroids, reduce the number of hospitalizations for treatment of multiple sclerosis, and reduce the burden of disease as seen on MRI scans

Treatment of a single clinical attack accompanied by development of clinically definite abnormal MRI scans in patients considered at high risk

Dimethyl fumarate (Tecfidera®)

(Oral capsules)

How it works:
Tecfidera® may work by changing the way the immune system works, to help keep it from further damaging the brain and spinal cord. The exact way that Tecfidera® works in MS is unknown.

Place in therapy:
Treatment of relapsing remitting multiple sclerosis to reduce the frequency of relapses and to slow the progression of physical symptoms

Natalizumab (Tysabri®)

(Solution for IV infusion 300 mg/15 mL)

How it works:
Alters the body's immune system to decrease further damage of the brain and spinal cord but the exact way it works is unknown.

Place in therapy:
Use as a single agent for the treatment of relapsing-remitting form of multiple sclerosis to reduce the frequency of relapses, decrease active brain lesions on MRI scans and to delay the progression of physical symptoms

This medication is generally recommended to patients who have had an inadequate response to, or are unable to tolerate, other therapies for multiple sclerosis

Usual adult dose
 

Teriflunomide (Aubagio®)

(Oral film-coated tablets)

14 mg orally daily for relapsing remitting MS.

This medication can be taken with or without food.

Do not stop taking this medication without discussing it with your doctor

Interferon Beta 1-A (Avonex®)

(Intra-muscular injection in prefilled syringes and in prefilled autoinjectors)

30 μg injected by intramuscular injection weekly for relapsing remitting MS or to delay MS progression

60 μg injected by intramuscular injection weekly for secondary progressive/relapsing progressive MS

Your doctor may start you at a lower dose and then gradually increase the dose to reduce flu-like symptoms associated with this medication initially

This medication is available in different forms. Speak to your doctor about the proper technique to use this medication

Interferon Beta 1-B (Betaseron®)

(Powder for subcutaneous injection 0.3 mg/vial)

0.25 mg injected by subcutaneous injection every other day at the same time (e.g. bedtime) for secondary progressive/relapsing-remitting MS.

Your doctor may start you at a lower dose and gradually increase the dose

Speak to your doctor regarding the proper technique to use this medication

Glatiramer acetate (Copaxone®)

(20 mg/1 mL prefilled syringes for subcutaneous injection)

20 mg injected by subcutaneous injection daily for clinically isolated syndrome and relapsing remitting MS.

Speak to your doctor regarding the proper technique to use this medication

Interferon Beta 1-B (Extavia®)

(Powder for subcutaneous injection 0.3 mg/vial)

0.25 mg injected by subcutaneous injection every other day at the same time (e.g. bedtime) for secondary progressive/relapsing-remitting MS

Your doctor may start you at a lower dose and gradually increase the dose

Speak to your doctor regarding the proper technique to use this medication

Fingolimod (Gilenya®)

(Oral capsules)

0.5 mg taken orally daily at the same time each day for relapsing-remitting MS

Your doctor may monitor your blood pressure, heart rate, and rhythm for at least 6 hours when you take the first dose of this medication

You should take this medication with half a glass of water. It can be taken with or without food

If you miss a dose of this medication, contact your doctor or pharmacist prior to taking the next dose

Alemtuzumab (Lemtrada®)

(12 mg/1.2 mL solution for IV infusion)

Initial treatment course: 12 mg infused intravenously over 4 hours daily for 5 consecutive days.

Second treatment course (12 months following initial course): 12 mg infused intravenously over 4 hours daily for 3 consecutive days. Lemtrada® is used for relapsing remitting MS.

Interferon Beta 1-A (Rebif®)

(Solution for injection in pre-filled syringes, pre-filled cartridges, and pre-filled pens)

44 μg injected by subcutaneous injection 3 times weekly for relapsing-remitting MS or for those who have experienced a first demyelinating event.

Your doctor may start you at a lower dose of this medication and gradually increase your dose to 44 μg

This medication is available in different dosage forms. Speak to your doctor about the proper technique to use this medication

Dimethyl fumarate (Tecfidera®)

(Oral capsules)

240 mg taken orally twice daily for relapsing-remitting MS

Your doctor may start you at an initial dose of 120 mg taken orally twice daily for 7 days before increasing it to the usual dose.

Do not crush, break, or dissolve the capsule

Taking the medication with food may reduce stomach upset caused by this medication. Your doctor may suggest altering the dose if side effects are bothersome

Natalizumab (Tysabri®)

(Solution for IV infusion 300 mg/15 mL)

300 mg infused intravenously every 4 weeks over approximately 1 hour for relapsing-remitting MS.

After the infusion your health care providers will observe you for up to 1 hour for possible infusion reactions

Side effects and
safety information

Teriflunomide (Aubagio®)

(Oral film-coated tablets)

Diarrhea, nausea, flu or sinus infection, upset stomach, abdominal pain, high blood pressure, liver disorder, numbness or tingling of hands or feet, rash, abnormal liver tests, hair thinning or loss

Speak with your doctor or a pharmacist if you experience any side effects, including high blood pressure, infections, fatigue, fever, yellowing of the skin or eyes, dark urine, nausea, loss of appetite, numbness and/or tingling of the hands or feet

Interferon Beta 1-A (Avonex®)

(Intra-muscular injection in prefilled syringes and in prefilled autoinjectors)

Common:
flu-like symptoms (e.g. headache, chills, muscle aches, fatigue)

Uncommon:
depression, seizures, heart problems, blood problems, liver problems, thyroid problems

Check with your doctor or pharmacist if you experience any side effects

Interferon Beta 1-B (Betaseron®)

(Powder for subcutaneous injection 0.3 mg/vial)

Very common:
rash

Common:
lack of coordinating in muscle movements, injection site reactions (e.g. redness or swelling at the injection site), flu-like symptoms (fever, chills, sweating, fatigue, muscle aches)

Uncommon:
depression or suicidal thoughts, fluid retention (e.g. swelling in ankles), seizures, symptoms of liver problems (e.g. yellowing of the skin, fatigue, dark urine, abdominal pain), difficulty breathing and/or swallowing, swelling of mouth and tongue

Check with your doctor or pharmacist if you experience any side effects

Glatiramer acetate (Copaxone®)

(20 mg/1 mL prefilled syringes for subcutaneous injection)

Common:
post injection reactions (e.g. flushing, dizziness, skin irritations, sweating, chest pain, chest tightness, irregular heartbeats, anxiety, difficulty breathing tightness in the throat, hives), blood pressure changes, dizziness, tiredness, nausea, headache, blurred vision, shortness of breath, heart rate changes, back, neck or joint pain, swelling of the arms, legs or face, depression, change in weight, lack of interest in regular activities, vision changes, allergic reactions

Check with your doctor or pharmacist if you experience any side effects

Interferon Beta 1-B (Extavia®)

(Powder for subcutaneous injection 0.3 mg/vial)

Very common:
fluid retention (e.g. swelling of ankles and legs)

Common:
injection-site reactions (e.g. redness or swelling at the site of injection), flu-like symptoms (fever, chills, sweating, fatigue, muscle aches), break in skin, rash

Uncommon:
seizures, depression or suicidal thoughts, liver problems (e.g. yellowing of the skin and eyes, fatigue, dark urine, abdominal pain), difficulty breathing and/or swallowing, swelling of mouth and tongue

Check with your doctor or pharmacist if you experience any side effects

Fingolimod (Gilenya®)

(Oral capsules)

Very common:
flu, headache, cough, diarrhea, back pain

Common:
sinusitis, fungal infections, dizziness, migraine, weakness, rash, eye pain, hair loss, itchy skin, weight loss, blurred vision, shortness of breath, numbness or tingling, or depression

This medication may impair your ability to drive or operate machinery on the first day of treatment

It may also slow your heart rate, especially during the first month of treatment

Check with your doctor or pharmacist if you experience any side effects

Alemtuzumab (Lemtrada®)

(12 mg/1.2 mL solution for IV infusion)

Very common during/shortly after infusion:
rash, hives, itching, fever, nausea, vomiting, headache, dizziness, difficulty sleeping

Very common after treatment:
headache, dizziness, rash, hives, itching, fever, nausea and vomiting, difficulty sleeping, back pain, joint pain, pain in arms or legs, upper respiratory tract infection/cough and cold, urinary tract, infection, chills, sore throat or mouth pain, feeling tired, bruising, tingling sensation, diarrhea

Common:
irregular heartbeat, chest discomfort, heartburn, stomach pain, constipation, flu, flu-like illness, cough, muscular pain or weakness, neck pain, swelling of the arms and/or legs, oral herpes (cold sores), altered taste, numbness, blurred vision, depression, anxiety, difficulty breathing, rash, redness of the skin, thyroid gland problems, nosebleeds

Interferon Beta 1-A (Rebif®)

(Solution for injection in pre-filled syringes, pre-filled cartridges, and pre-filled pens)

Common:
flu-like symptoms (e.g. headache, fever, chills, muscle aches, fatigue, nausea), injection site reactions (e.g. redness, swelling, pain, skin breakdown, discoloration and inflammation at injection site)

Uncommon:
liver injury (e.g. loss of appetite, nausea, dark urine), depression, heart problems, seizures, thyroid problems

Check with your doctor or pharmacist if you experience any side effects

Dimethyl fumarate (Tecfidera®)

(Oral capsules)

Common:
Flushing and stomach upset (diarrhea, nausea, stomach pain, vomiting, indigestion)

Side effects are more common during the first month of treatment and tend to improve with time

Natalizumab (Tysabri®)

(Solution for IV infusion 300 mg/15 mL)

Common:
urinary bladder infection, sore throat and runny or blocked nose, shivering, itchy hives, headache, dizziness, nausea, vomiting, joint pain, fever, tenderness

Check with your doctor or pharmacist if you experience any side effects

Other information
 

Teriflunomide (Aubagio®)

(Oral film-coated tablets)

This medication is not recommended for women who are pregnant or who are of childbearing age and are not using reliable birth control. It is also not recommended for men considering fathering a child. The medication can cause damage to the fetus if it is taken at the same time and up to 2 years after stopping the medication. It is also not recommended for people with severe liver disease, immune-deficiency conditions (e.g. AIDS), serious active infections, bone marrow disease (e.g. anemia), and/or a sensitivity to leflunomide

Aubagio may cause liver disorders as well as severe liver injury in patients treated with drugs that are similar. The risk of severe liver disorder increases if you already have liver disease or taking drugs that affect the liver.

Special Storage information:
Store this medication between 20ºC to 25ºC. For blister card wallet, remove tablet only when ready to use. Once the bottle is opened, the tablets must be used within 90 days.

Interferon Beta 1-A (Avonex®)

(Intra-muscular injection in prefilled syringes and in prefilled autoinjectors)

This medication is not recommended for pregnant women because it may cause a miscarriage

You should talk to your doctor if you are breast feeding an infant while on this medication.

Before starting this medication, speak to your doctor about your medical history, including any history of depression, anxiety, thyroid gland problems, blood problems, history of seizures, heart problems, liver disease, or planning to become pregnant

Special Storage information:
This medication should be stored in a refrigerator. It may be stored at room temperature for up to one week.

Prior to using this medication, let it warm at room temperature for 30 minutes

Interferon Beta 1-B (Betaseron®)

(Powder for subcutaneous injection 0.3 mg/vial)

This medication should not be used in pregnant or lactating women due to an increased risk of spontaneous abortion.

Before starting this medication, speak with your doctor about your medical history including any history of depression, anxiety, liver problems, epilepsy, heart problems, problems with the thyroid gland, currently pregnant or breast-feeding, considering becoming pregnant

Special storage information:
This medication may be refrigerated or stored at room temperature (between 25°C -30°C) up to a maximum of 30 days. Once prepared, it must be refrigerated and used within 3 hours

Glatiramer acetate (Copaxone®)

(20 mg/1 mL prefilled syringes for subcutaneous injection)

This medication is not recommended for use in pregnancy.

Before starting this medication, speak to your doctor about your medical history including any history of heart or respiratory diseases, severe allergic reactions, currently pregnant or breast-feeding, considering becoming pregnant

Special storage information:
This medication should be stored in the refrigerator. It may be stored at room temperature for one month

Interferon Beta 1-B (Extavia®)

(Powder for subcutaneous injection 0.3 mg/vial)

This medication should not be used in pregnant women.

Before starting this medication, speak to your doctor about your medical history, including any history of depression, anxiety, liver problems, epilepsy, heart problems, problems with the thyroid gland, currently pregnant or breast-feeding, considering becoming pregnant

Special storage information:
This medication may be stored at room temperature or in the refrigerator. Once prepared, the medication must be refrigerated and used within 3 hours

Fingolimod (Gilenya®)

(Oral capsules)

This medication should not be used in pregnant women.

Before starting this medication, speak to your doctor about your medical history, including your history of heart disease, stroke, sleep apnea, diabetes , visual disturbances, irregular or slow heart rate, weakened immune system, vaccination history, chickenpox, vision issues, liver problems, blood pressure issues, cholesterol issues, kidney problems and lung issues

Also speak to your doctor or pharmacist if you're currently taking medications for irregular or slow heartbeat, or medications to suppress the immune system

If you are taking any other medications in addition to this medication, you should discuss this with your doctor

This medication is not recommended for people with an increased risk of developing opportunistic infections or people with severe active infections, active malignancies, and/or severe liver disease

Special Storage information:
Store this medication between 15ºC to 25ºC. Store it in the original package and protect from moisture. Keep out of reach and sight of children.

Alemtuzumab (Lemtrada®)

(12 mg/1.2 mL solution for IV infusion)

This medication is not recommended for use in pregnant women.

This medication can cause serious autoimmune conditions and kidney disease in patients.

This medication is not recommended for people with infections (including active or latent tuberculosis, HIV, history of progressive multifocal leukoencephalopathy) or active malignancies, or people using cancer treatment medications such as immune-suppressants

Your doctor may regularly monitor your urine and blood for side effects

Before starting this medication, speak to your doctor about your medical history and your risk of developing autoimmune diseases or severe infections (e.g., progressive multifocal leukoencephalopathy)

Special storage information:
This medication should be stored in the refrigerator and protected from light. Do not freeze or shake the medication.

Interferon Beta 1-A (Rebif®)

(Solution for injection in pre-filled syringes, pre-filled cartridges, and pre-filled pens)

This medication is not recommended for people who have severe liver disease, currently pregnant or are thinking of becoming pregnant.

Before starting this medication, speak to your doctor about your medical history, including any history of heart disease, severe renal failure, severe decrease in the development of blood cells, pre-existing seizure disorder, depression or suicidal thoughts, liver problems, or problems with the thyroid gland, currently pregnant or breastfeeding, considering becoming pregnant

Special storage information:
This medication should be stored in a refrigerator. It may be stored at room temperature for up to one month

Dimethyl fumarate (Tecfidera®)

(Oral capsules)

There is no substantial information regarding Tecfidera® and its use in pregnancy. Inform your doctor if you are pregnant or plan on becoming pregnant.

Your doctor may regularly monitor your urine and blood for side effects

Check with your doctor before getting any vaccinations, as this drug may affect the vaccine's effectiveness

Before starting this medication talk to your doctor about your medical history, low lymphocyte count, immunodeficiency issues, any bone marrow transplants, if you have an infection, liver or kidney disease, stomach or bowel disease and if you are pregnant or breastfeeding.

Birth control pills may be less effective while on this medication. A backup method should be considered

Special storage information:
This medication should be stored at room temperature (between 15-30ºC) and protected from light. Store the capsules in their original packaging.

Natalizumab (Tysabri®)

(Solution for IV infusion 300 mg/15 mL)

There is no substantial information regarding Tysabri® and its use in pregnancy. Inform your doctor if you are pregnant or plan on becoming pregnant

This medication is not recommended for people who are immuno compromised due to a disease or medications or for people who have had or have progressive multifocal leukoencephalopathy

Before starting this medication, speak to your doctor about your medical history as well as your risks of developing an infection called progressive multifocal leukoencephalopathy

Special storage information:
This medication should be stored in a refrigerator and protected from light.