IFN-Beta 1a (Avonex)

MECH: Inhibits T-cell activation; Cytokine profile shifts from Th1 to Th2 (anti-inflammatory); Inhibits lymphocyte migration into CNS; Apoptosis of auto-reactive T-cells.

USE: For RRMS to reduce severity and frequency of attacks. Does not cross BBB.

AE: Flu-like; Irritation at injection site; Mild anemia; elevated liver enzymes; hypothyroidism. Neutralizing Antibodies (Nabs) to IFN-Beta preps can reduce efficacy of the drug--monitor!

MECH: Same as Avonex but higher concentration.

USE: For RRMS to reduce severity and frequency of attacks. Does not cross BBB.

AE: More side effects than Avonex: Flu-like; injection site reaction; Menstrual interactions; depression; Leukopenia/anemia; elevated liver enzymes; hypothyroidism.  Antibodies (Nabs) to IFN-Beta preps can reduce efficacy of the drug--monitor!

MECH: Inhibits T-cell activation; Cytokine profile shifts from Th1 to Th2 (anti-inflammatory); Inhibits lymphocyte migration into CNS; Apoptosis of auto-reactive T-cells.

USE: For RRMS to reduce severity and frequency of attacks. Does not cross BBB.

AE: More side effects than Avonex: Flu-like; injection site reaction; Menstrual interactions; depression; Leukopenia/anemia; elevated liver enzymes; hypothyroidism. Antibodies (Nabs) to IFN-Beta preps can reduce efficacy of the drug--monitor! Betaferon is strongest inducer of this reaction.

MECH: Analog of Myelin Basic Protein (MBP) which induces Tregs toward an anti-inflammatory reaction.

USE: For RRMS. Decreases brain atrophy and decreases relapse rate by ~1/3. As effective as high dose interferons.

AE: Mild side effects. Injection site reaction, anxiety-like reaction.

MECH: Binds alpha-4 subunit of integrins expressed on leukocyte surgace and inhibit migration through the BBB.

USE: Second line therapy for RRMS.

AE: Progressive Multifocal Leukoencephalopathy (PML) risk (caused by activation of JC virus). Headache, dizziness, fatigue, arthralgia and rigors -- especially when Nabs develop.

MECH: Prodrug with structural similarity to sphingosine-1-phosphate (S1P) modulates S1P receptor sequestering lymphocytes in lymph nodes preventing them from reaching brain.

USE: Oral drug for RRMS.

AE: Bradycardia and heart block; macular edema. Must have VZV antibodies to use--may have to vaccinate patient and wait before using.

MECH: Synthetic anthracenedione alkylates DNA. Broadly immunosuppressive.

USE: Secondary progressive MS (SPMS).

AE: N+V; Alopecia; amenorea; more infections; Cardiac toxicity may induce irreversable CHF. Can induce Acute leukemia.