Managing the Disease Course

Several medications called disease-modifying treatments (DMTs) or disease-modifying drugs (DMDs) have been shown to be effective in decreasing the frequency of relapses or exacerbations and decreasing the development of lesions or plaques in the brain or spinal cord.1

What are disease-modifying therapies?

Disease-modifying therapies have been shown to reduce the frequency and severity of MS attacks, or relapses. DMTs can slow the accumulation of MS lesions in the brain and spinal cord and can slow the progression of disability. There are several DMTs approved by the U.S. Food and Drug Administration (FDA) for the treatment of MS which are listed in the table below. Only one – Ocrevus™ (ocrelizumab) – is approved to treat primary progressive MS (PPMS), as well as relapsing forms of MS.1-3

First-line vs. second-line options

Many of these medications are considered to be first-line options – in other words, the initial choice of drug therapy for treating patients who are diagnosed with MS. Others are second-line drug treatment options in the US, which means that they are reserved for people who have not responded adequately to first-line drugs.

Disease-modifying treatments for MS

DRUG
INDICATION
ADMINISTRATION
Betaseron® (interferon beta-1b)
CIS, relapsing-remitting MS, and active SPMS
Subcutaneous injection
Avonex® (interferon beta-1a)
CIS, relapsing-remitting MS, and active SPMS
Intramuscular injection
Rebif® (interferon beta-1a)
CIS, relapsing-remitting MS, and active SPMS
Subcutaneous injection
Extavia® (interferon beta-1b)
CIS, relapsing-remitting MS, and active SPMS
Subcutaneous injection
Plegridy® (Peginterferon beta-1a)
CIS, relapsing-remitting MS, and active SPMS
Intramuscular injection
Copaxone® (glatiramer acetate)
CIS, relapsing-remitting MS, and active SPMS
Subcutaneous injection
Tysabri® (natalizumab)
CIS, relapsing-remitting MS, and active SPMS
IV infusion
Lemtrada® (alemtuzumab)
Relapsing-remitting MS and active SPMS; reserved for patients with inadequate response to two or more drugs
IV infusion
Ocrevus™ (ocrelizumab)
CIS, relapsing-remitting MS, active SPMS, and PPMS
IV infusion
Tecfidera® (dimethyl fumarate)
CIS, relapsing-remitting MS, and active SPMS
Oral
Aubagio® (teriflunomide)
CIS, relapsing-remitting MS, and active SPMS
Oral
Gilenya® (fingolimod)
CIS, relapsing-remitting MS, active SPMS, and pediatric MS
Oral
Novantrone® (mitoxantrone)
SPMS or worsening relapsing-remitting MS
IV infusion
Mavenclad® (cladribine)
Relapsing-remitting MS or active SPMS
Oral
Mayzent® (siponimod)
CIS, relapsing-remitting MS, or active SPMS
Oral
Vumerity® (diroximel fumarate)
CIS, relapsing-remitting MS, and active SPMS
Oral
Zeposia (ozanimod)
CIS, relapsing-remitting MS, and active SPMS
Oral
Kesimpta® (ofatumumab)
CIS, relapsing-remitting MS, and active SPMS
Subcutaneous injection

How do you choose between different MS treatments?

With so many disease-modifying-therapies available, it is important to know the differences between these drugs so that you and your doctor might select one over another for your treatment. Some of the drugs described above are indicated (approved for a specific use) as the initial or first-line treatment for persons with MS and/or CIS. Others are second-line treatment options for persons who have not responded adequately to a first-line drug.4-17 In some cases, the choice among drugs is made according to the following considerations:

  • Side effects associated with each
  • MS disease course, as some drugs may be more effective than others in one disease course versus another
  • Lifestyle considerations, such as whether a person is able to give him or herself an injection
  • Desire to become pregnant, as some drugs are not recommended during pregnancy
  • Insurance coverage or generic availability
  • Patient’s comorbidities or other disease states

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Written by Emily Downward | Last review date: February 2021.