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

Comparison by route of administration

Subcutaneous injections:

  • Betaseron® (interferon beta-1b)
  • Rebif® (interferon beta-1a)
  • Extavia® (interferon beta-1b)
  • Plegridy® (Peginterferon beta-1a)
  • Copaxone® (glatiramer acetate)
  • Zinbryta® (daclizumab)

Intramuscular injection:

  • Avonex® (interferon beta-1a)

IV infusions:

  • Tysabri® (natalizumab)
  • Lemtrada® (alemtuzumab)
  • Ocrevus™ (ocrelizumab)
  • Novantrone® (mitoxantrone)

Oral medications:

  • Tecfidera® (dimethyl fumarate)
  • Aubagio® (teriflunomide)
  • Gilenya® (fingolimod)

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.

  • Aubagio (teriflunomide) – Headache, diarrhea, nausea, hair loss, increased liver enzymes4
  • Avonex (interferon beta-1a) – 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 energy5
  • Betaseron (interferon beta-1b) – 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 energy6
  • Copaxone (glatiramer acetate) – Reactions at the injection site, lowered blood pressure, rash, difficulty breathing, and chest pain7
  • Extavia (interferon beta-1b) – 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 energy8
  • Gilenya (fingolimod) – Headache, diarrhea, increased liver enzymes, cough, flu-like symptoms, sinus symptoms, infections, back pain, abdominal pain, and pain in the arms and legs9
  • Lemtrada (alemtuzumab) – 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, flushing10
  • Novantrone (mitoxantrone) – Nausea, hair loss, urinary tract infection, menstrual disorders (including amenorrhea), weakness or lack of energy11
  • Ocrevus (ocrelizumab) – Infusion-related reactions and upper respiratory tract infections3
  • Plegridy (Peginterferon beta-1a) – 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
  • Rebif (interferon beta-1a) – 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 energy13
  • Tecfidera (dimethyl fumarate) – Flushing, abdominal pain, diarrhea, nausea14
  • Tysabri (natalizumab) – 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, rash15
  • Zinbryta (daclizumab) – Inflammation of the nasal passages and throat, upper respiratory tract infection, flu-like symptoms, swollen lymph nodes, skin reactions, bronchitis, depression, sore throat, increased liver enzymes16

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.

  • Aubagio (teriflunomide) – 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 counts4
  • Avonex (interferon beta-1a) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts5
  • Betaseron (interferon beta-1b) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts6
  • Copaxone (glatiramer acetate) – Post-injection reaction (rapid heartbeat, anxiety, throat constriction)7
  • Extavia (interferon beta-1b) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts8
  • Gilenya (fingolimod) – 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 carcinoma9
  • Lemtrada (alemtuzumab) – 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)10
  • Novantrone (mitoxantrone) – 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 failure11
  • Ocrevus (ocrelizumab) – Infusion-related reactions, infections, increased risk of certain cancers3
  • Plegridy (Peginterferon beta-1a) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts12
  • Rebif (interferon beta-1a) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts13
  • Tecfidera (dimethyl fumarate) – 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 legs14
  • Tysabri (natalizumab) – 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 injury15
  • Zinbryta (daclizumab) – Liver injury (including autoimmune hepatitis), other immune-mediated disorders, infections, severe allergic reaction, depression and suicidal thoughts16
Written by Emily Downward | Last review date: April 2018.
View References
  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 4/13/18.
  2. Learn about clinical studies. U.S. National Library of Medicine. Available at https://clinicaltrials.gov/ct2/about-studies/learn#ClinicalTrials. Accessed 4/13/18.
  3. Ocrevus prescribing information. Available at https://www.gene.com/download/pdf/ocrevus_prescribing.pdf. Accessed 4/6/18.
  4. Aubagio prescribing information. Available at http://products.sanofi.us/Aubagio/Aubagio.pdf. Accessed 4/6/18.
  5. 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.
  6. Betaseron prescribing information. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/103471s5157lbl.pdf. Accessed 4/6/18.
  7. Copaxone prescribing information. Available at https://www.copaxone.com/Resources/pdfs/PrescribingInformation.pdf. Accessed 4/6/18.
  8. Extavia prescribing information. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/125290s0000lbl.pdf. Accessed 4/6/18.
  9. Gilenya prescribing information. Available at https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/gilenya.pdf. Accessed 4/6/18.
  10. Lemtrada prescribing information. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/103948s5139lbl.pdf. Accessed 4/6/18.
  11. Novantrone prescribing information. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019297s030s031lbl.pdf. Accessed 4/6/18.
  12. 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.
  13. Rebif prescribing information. Available at http://www.emdserono.com/ms.country.us/en/images/Rebif_PI_tcm115_140051.pdf. Accessed 4/6/18.
  14. 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.
  15. 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.
  16. Zinbryta prescribing information. Available at https://www.zinbryta.com/content/dam/commercial/multiple-sclerosis/zinbryta/na/en_us/pdfs/zinbryta-prescribing-information.pdf. Accessed 4/6/18.