Comparison Review of MS Drugs

Disease-modifying therapies (DMTs) are currently the best way to slow the progression of multiple sclerosis (MS), and there are several DMTs available on the market which are listed in the table below. When considering which treatment is best, each individual should talk to their doctor about the treatment options that are right for their unique situation, as well as all the potential benefits and risks of each treatment.1

MS is a disease that greatly varies in how it affects different individuals, in the symptoms presented, the rate of progression of the disease, and the frequency and severity of relapses or exacerbations. How a particular drug works in one person may be very different from how it works in another person. It is helpful to keep in mind these variations between individuals when considering which treatment to choose, and each person should work with their doctor to find the best remedies for them.

Considerations when choosing between different treatments

Common considerations when choosing between different treatments include:

  • Cost
  • Effectiveness
  • Side Effects/Safety
  • Route of Administration

Cost will vary based on each individual’s health insurance coverage and benefits. Several of the drug manufacturers have patient assistance programs that can also help cover the cost of medications.

Regarding effectiveness, all drugs that receive approval from the U.S. Food and Drug Administration must undergo several controlled clinical trials to demonstrate that the product is effective and safe. During some of these trials, new potential treatments may be compared to existing standard treatments, called head-to-head studies.2 However, there is no one trial or source of information that compares all of the current DMTs to each other. All of the DMTs available have demonstrated through clinical trials that they reduce the frequency and severity of relapses or exacerbations of relapsing forms of MS, reduce the development of new lesions, and appear to slow down the progression and disability of the disease.1 Only one DMT, Ocrevus™ (ocrelizumab), has demonstrated efficacy in both relapsing forms and primary progressive MS (PPMS).3

A comparison of the different routes of administration and side effect profiles of DMTs is below.3-17

Side Effects and Administration of Disease-Modifying Therapies in MS

Medication
Route of administration
Common side effects
Safety concerns
Betaseron® (interferon beta-1b)
Subcutaneous injection
Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
Avonex® (interferon beta-1a)
Intramuscular injection
Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
Rebif® (interferon beta-1a)
Subcutaneous injection
Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
Extavia® (interferon beta-1b)
Subcutaneous injection
Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
Plegridy® (Peginterferon beta-1a)
Subcutaneous injection
Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
Copaxone® (glatiramer acetate)
Subcutaneous injection
Reactions at the injection site, lowered blood pressure, rash, difficulty breathing, and chest pain
Post-injection reaction (rapid heartbeat, anxiety, throat constriction)
Tysabri® (natalizumab)
IV infusion
Headache, fatigue, joint pain, urinary tract infection, lower respiratory tract infection, inflammation in the stomach, vaginal infection, depression, pain in arms or legs, abdominal discomfort, diarrhea, rash
Rare viral disease (progressive multifocal leukoencephalopathy), severe allergic reactions, suppression of the immune system, increased risk of infections (including herpes simplex virus, meningitis, and hepatitis B virus infection with acute fatal liver injury), liver injury
Lemtrada® (alemtuzumab)
IV infusion
Rash, headache, fever, inflammation of the nasal passages and throat, nausea, vomiting, infection (urinary tract, upper respiratory tract, viral including herpes, fungal), fatigue, insomnia, red welts on skin, itching, thyroid gland disorders, joint pain, pain in arms or legs, back pain, mouth and throat pain, abdominal pain, diarrhea, sinus infection, tingling or prickling sensation, dizziness, flushing
Infusion-associated reactions and severe allergic reaction, thyroid disorders, increased risk of certain cancers, infections (including opportunistic such as herpes virus, human papilloma virus, fungal infections, listeria, and nocardiosis)
Ocrevus™ (ocrelizumab)
IV infusion
Infusion-related reactions and upper respiratory tract infections
Infusion-related reactions, infections, increased risk of certain cancers
Tecfidera® (dimethyl fumarate)
Oral
Flushing, abdominal pain, diarrhea, nausea
Severe allergic reaction, lowered white blood cell counts, liver injury, rare viral disease (progressive multifocal leukoencephalopathy),
swelling (angioedema) in the face, tongue, throat, abdomen, arms or legs
Aubagio® (teriflunomide)
Oral
Headache, diarrhea, nausea, hair loss, increased liver enzymes
Liver injury, risk of causing birth defects, bone marrow effects, suppression of the immune system, infection, peripheral neuropathy, skin conditions, increased blood pressure, respiratory effects, pancreatitis, lowered white blood cell counts
Gilenya® (fingolimod)
Oral
Headache, diarrhea, increased liver enzymes, cough, flu-like symptoms, sinus symptoms, infections, back pain, abdominal pain, and pain in the arms and legs
Change in heart rhythm that may cause sudden death, infections, (progressive multifocal leukoencephalopathy), increased fluid in the retina (macular edema), posterior reversible encephalopathy syndrome, respiratory effects, liver injury, risk of causing birth defects, increased blood pressure, basal cell carcinoma
Novantrone® (mitoxantrone)
IV infusion
Nausea, hair loss, urinary tract infection, menstrual disorders (including amenorrhea), weakness or lack of energy
Congestive heart failure (can result in death) may occur either during or months to years after termination of therapy. Secondary acute myeloid leukemia, infection, lowered white blood cell counts, depression, bone pain, vomiting, kidney failure
Written by Emily Downward | Last review date: April 2018.
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