Section 04
MS & Neuroimmunology
Disease-Modifying Therapies
28 AGENTS
Interferon beta-1a
Avonex / RebifInterferon
- Forms
- Avonex IM: 30mcg/0.5mL | Rebif SC: 22, 44mcg
- Dose
- weekly (Avonex) or 3x/wk (Rebif)
- MOA
- Immunomodulatory, ↓T-cell activation
Peginterferon beta-1a
PlegridyInterferon (pegylated)
- Forms
- SC: 63, 94, 125mcg
- Dose
- every 14 days
- MOA
- Immunomodulatory, ↓T-cell activation
Interferon beta-1b
Betaseron / ExtaviaInterferon
- Forms
- SC: 0.3mg/mL
- Dose
- every other day
- MOA
- Immunomodulatory, ↓T-cell activation
Glatiramer acetate
CopaxoneImmunomodulator
- Forms
- SC: 20mg/mL, 40mg/mL
- Dose
- 20mg daily or 40mg 3x/week
- MOA
- Shifts T-cells toward anti-inflammatory Th2
Dimethyl fumarate
TecfideraNrf2 activator
- Forms
- Cap: 120, 240mg
- Dose
- Start 120mg BID x7d, then 240mg BID
- MOA
- Activates Nrf2 antioxidant pathway
Diroximel fumarate
VumerityNrf2 activator
- Forms
- Cap: 231mg
- Dose
- Start 231mg BID x7d, then 462mg BID
- MOA
- Activates Nrf2 antioxidant pathway
Monomethyl fumarate
BafiertamNrf2 activator
- Forms
- Cap: 95, 190mg
- Dose
- Start 95mg BID x7d, then 190mg BID
- MOA
- Activates Nrf2 antioxidant pathway
Teriflunomide
AubagioPyrimidine synthesis inhibitor
- Forms
- Tab: 7, 14mg
- Dose
- 14mg once daily
- MOA
- Inhibits DHODH, ↓lymphocyte proliferation
Fingolimod
GilenyaS1P receptor modulator
- Forms
- Cap: 0.25, 0.5mg
- Dose
- Start 0.5mg once daily; 1st-dose cardiac monitoring
- MOA
- Traps lymphocytes in lymph nodes
Siponimod
MayzentS1P receptor modulator
- Forms
- Tab: 0.25, 1, 2mg
- Dose
- Titrate over 5-6 days to 2mg once daily
- MOA
- Traps lymphocytes in lymph nodes
Ozanimod
ZeposiaS1P receptor modulator
- Forms
- Cap: 0.23, 0.46, 0.92mg
- Dose
- Titrate over 7 days to 0.92mg once daily
- MOA
- Traps lymphocytes in lymph nodes
Ponesimod
PonvoryS1P receptor modulator
- Forms
- Tab: 2, 3, 4, 5, 6, 7, 8, 9, 10, 20mg
- Dose
- Titrate over 14 days to 20mg once daily
- MOA
- Traps lymphocytes in lymph nodes
Natalizumab
TysabriAnti-α4 integrin mAb
- Forms
- IV/SC: 300mg
- Dose
- 300mg every 4 weeks
- MOA
- Blocks lymphocyte migration across BBB
Ocrelizumab
OcrevusAnti-CD20 mAb
- Forms
- IV: 300mg/10mL
- Dose
- 300mg IV, repeat in 2 weeks; then 600mg IV every 6 months
- MOA
- Depletes CD20+ B-cells
Ofatumumab
KesimptaAnti-CD20 mAb
- Forms
- SC pen: 20mg
- Dose
- 20mg Wk0,1,2, then 20mg monthly starting Wk4
- MOA
- Depletes CD20+ B-cells
Alemtuzumab
LemtradaAnti-CD52 mAb
- Forms
- IV: 12mg/1.2mL
- Dose
- 12mg/day x5 days, then 12mg/day x3 days 1yr later
- MOA
- Depletes CD52+ lymphocytes
Cladribine
MavencladPurine analog
- Forms
- Tab: 10mg, weight-based
- Dose
- 2 short oral courses 1 year apart
- MOA
- Selective lymphocyte depletion
Mitoxantrone
NovantroneAnthracenedione (chemo)
- Forms
- IV: 2mg/mL
- Dose
- 12mg/m² every 3 months (lifetime dose cap)
- MOA
- Intercalates DNA, immunosuppressive
Dalfampridine
AmpyraK+ channel blocker
- Forms
- ER tab: 10mg
- Dose
- 10mg BID (walking speed)
- MOA
- Improves axonal conduction in demyelinated fibers
Methylprednisolone
Solu-MedrolCorticosteroid
- Forms
- IV: 40, 125, 500, 1000mg vials
- Dose
- 500-1000mg/day x3-5d (relapse)
- MOA
- Broad anti-inflammatory/immunosuppressive
Rituximab
RituxanAnti-CD20 mAb (off-label)
- Forms
- IV: 10mg/mL vial
- Dose
- protocol-dependent dosing
- MOA
- Depletes CD20+ B-cells
Eculizumab
SolirisComplement C5 inhibitor
- Forms
- IV: 300mg/30mL (10mg/mL)
- Dose
- 900mg weekly x4wk, then 1200mg at wk5, then 1200mg q2wk
- MOA
- Blocks C5 cleavage, prevents membrane attack complex
Inebilizumab
UpliznaAnti-CD19 mAb
- Forms
- IV: 100mg/10mL
- Dose
- 300mg IV, repeat in 2 weeks, then 300mg every 6 months
- MOA
- Depletes CD19+ B-cells
Satralizumab
EnspryngAnti-IL-6 receptor mAb
- Forms
- SC: 120mg/mL
- Dose
- 120mg Wk0,2,4, then every 4 weeks
- MOA
- Blocks IL-6 signaling
Ublituximab
BriumviAnti-CD20 mAb
- Forms
- IV: 150mg/6mL (25mg/mL)
- Dose
- 150mg IV Day 1, 450mg IV Day 15, then 450mg IV every 24 weeks
- MOA
- Depletes CD20+ B-cells
Ocrelizumab + hyaluronidase
Ocrevus ZunovoAnti-CD20 mAb · SC
- Forms
- SC: 920mg/23,000 units per 23mL vial
- Dose
- 920mg SC every 6 months; premedicate with dexamethasone 20mg + antihistamine
- MOA
- Depletes CD20+ B-cells
Corticotropin (ACTH)
Acthar GelHormone (ACTH)
- Forms
- Inj: 80 units/mL (5mL vial)
- Dose
- 80-120 units/day IM/SC x2-3 weeks (MS exacerbation)
- MOA
- Stimulates adrenal steroidogenesis
Natalizumab-sztn
TyrukoAnti-α4 integrin mAb (biosimilar)
- Forms
- IV: 300mg/15mL vial
- Dose
- 300mg IV every 4 weeks (natalizumab biosimilar; REMS for PML risk)
- MOA
- Blocks lymphocyte migration across the blood-brain barrier