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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

Treatment experiences can vary

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 of different MS treatments

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.

MS treatment safety and effectiveness

All drugs that receive approval from the U.S. Food and Drug Administration must undergo several controlled clinical trials to prove 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

Slowing down progression and reducing relapses

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, ocrelizumab (Ocrevus®), has demonstrated efficacy in both relapsing forms and primary progressive MS (PPMS).3

Comparison by route of administration

Subcutaneous injections:

  • Interferon beta-1a (Rebif®)
  • Interferon beta-1b (Betaseron®)
  • Interferon beta-1b (Extavia®)
  • Glatiramer acetate (Copaxone®)
  • Peginterferon beta-1a (Plegridy®)

Intramuscular injection:

  • Interferon beta-1a (Avonex®)

IV infusions:

  • Alemtuzumab (Lemtrada®)
  • Mitoxantrone (Novantrone®)
  • Natalizumab (Tysabri®)
  • Ocrelizumab (Ocrevus®)

Oral medications:

  • Cladribine (Mavenclad®)
  • Dimethyl fumarate (Tecfidera®)
  • Fingolimod (Gilenya®)
  • Siponimod (Mayzent®)
  • Teriflunomide (Aubagio®)

Comparison by common side effects

All medications can cause unwanted side effects. However, not all patients experience the same side effects. The side effects listed below are not all the possible side effects that these medications may cause. Individuals should talk to their doctor about what to expect and report any concerns to their doctor.

  • Alemtuzumab (Lemtrada®) – 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, flushing4
  • Cladribine (Mavenclad®) – Upper respiratory tract infection, headache, lymphopenia5
  • Dimethyl fumarate (Tecfidera®) – Flushing, abdominal pain, diarrhea, nausea6
  • Fingolimod (Gilenya®) – Headache, diarrhea, increased liver enzymes, cough, flu-like symptoms, sinus symptoms, infections, back pain, abdominal pain, and pain in the arms and legs7
  • Glatiramer acetate (Copaxone®) – Reactions at the injection site, lowered blood pressure, rash, difficulty breathing, and chest pain8
  • Interferon beta-1b (Extavia®) – 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 energy9
  • Interferon beta-1a (Avonex®) – 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 energy10
  • Interferon beta-1a (Rebif®) – 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 energy11
  • Interferon beta-1b (Betaseron®) – 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 energy12
  • Mitoxantrone (Novantrone®) – Nausea, hair loss, urinary tract infection, menstrual disorders (including amenorrhea), weakness or lack of energy13
  • Natalizumab (Tysabri®) – 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, rash14
  • Ocrelizumab (Ocrevus®) – Infusion-related reactions and upper respiratory tract infections3
  • Peginterferon beta-1a (Plegridy®) – 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 energy15
  • Siponimod (Mayzent®) – Headache, high blood pressure, increased liver enzymes16
  • Teriflunomide (Aubagio®) – Headache, diarrhea, nausea, hair loss, increased liver enzymes17

Comparison by safety concerns

While rare, DMTs may cause serious side effects. Not everyone who takes these medications experiences serious side effects. Individuals should discuss all safety concerns with their doctor prior to beginning treatment with a DMT.

  • Alemtuzumab (Lemtrada®) – 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)4
  • Cladribine (Mavenclad®) – Increased risk of infections and malignancies, worsening of chronic infections such as HIV, hepatitis or TB, fetal harm.5
  • Dimethyl fumarate (Tecfidera®) – 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 legs6
  • Fingolimod (Gilenya®) – 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 carcinoma7
  • Glatiramer acetate ( Copaxone®) – Post-injection reaction (rapid heartbeat, anxiety, throat constriction)8
  • Interferon beta-1a (Avonex®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts9
  • Interferon beta-1a (Rebif®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts10
  • Interferon beta-1b (Betaseron®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts11
  • Interferon beta-1b (Extavia®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts12
  • Mitoxantrone (Novantrone®) – 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 failure13
  • Natalizumab (Tysabri®) – 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 injury14
  • Ocrelizumab (Ocrevus®) – Infusion-related reactions, infections, increased risk of certain cancers3
  • Peginterferon beta-1a (Plegridy®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts15
  • Siponimod (Mayzent®) – Macular edema, increased risk of infections, decrease in heart rate16
  • Teriflunomide (Aubagio®) – 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 counts17
Written by Jessica Johns Pool | Last review date: July 2019.
  1. Disease-modifying therapies for MS. National MS Society. Available at http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-The-MS-Disease-Modifying-Medications.pdf. Accessed 10/29/19.
  2. Learn about clinical studies. U.S. National Library of Medicine. Available at https://clinicaltrials.gov/ct2/about-studies/learn#ClinicalTrials. Accessed 10/29/19.
  3. Ocrevus prescribing information. Available at https://www.gene.com/download/pdf/ocrevus_prescribing.pdf. Accessed 4/6/18.
  4. Lemtrada prescribing information. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/103948s5139lbl.pdf. Accessed 4/6/18.
  5. Mavenclad Prescribing Information. Available at: https://www.emdserono.com/content/dam/web/corporate/non-images/country-specifics/us/pi/mavenclad-pi.pdf. Accessed 10/29/19.
  6. Tecfidera prescribing information. Available at https://www.tecfidera.com/content/dam/commercial/multiple-sclerosis/tecfidera/pat/en_us/pdf/full-prescribing-info.pdf. Accessed 4/6/18.
  7. Gilenya prescribing information. Available at https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/gilenya.pdf. Accessed 4/6/18.
  8. Copaxone prescribing information. Available at https://www.copaxone.com/Resources/pdfs/PrescribingInformation.pdf. Accessed 4/6/18.
  9. Extavia prescribing information. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/125290s0000lbl.pdf. Accessed 4/6/18.
  10. Avonex prescribing information. Available at https://www.avonex.com/content/dam/commercial/multiple-sclerosis/avonex/pat/en_us/pdf/Avonex%20US%20%20Prescribing%20Information.pdf? Accessed 4/6/18.
  11. Rebif prescribing information. Available at http://www.emdserono.com/ms.country.us/en/images/Rebif_PI_tcm115_140051.pdf. Accessed 4/6/18.
  12. Betaseron prescribing information. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/103471s5157lbl.pdf. Accessed 4/6/18.
  13. Novantrone prescribing information. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019297s030s031lbl.pdf. Accessed 4/6/18.
  14. Tysabri prescribing information. Available at https://www.tysabri.com/content/dam/commercial/multiple-sclerosis/tysabri/pat/en_us/pdfs/tysabri_prescribing_information.pdf. Accessed 4/6/18.
  15. Plegridy prescribing information. Available at https://www.plegridy.com/content/dam/commercial/multiple-sclerosis/plegridy/pat/en_us/pdf/plegridy-prescribing-information.pdf. Accessed 4/6/18.
  16. Mayzent prescribing information. Available at https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/mayzent.pdf. Accessed 10/29/19.
  17. Aubagio prescribing information. Available at http://products.sanofi.us/Aubagio/Aubagio.pdf. Accessed 4/6/18.