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Relapsing MS generally encompasses clinically isolated syndrome, relapsing-remitting MS, and active secondary-progressive MS. The U.S. Food and Drug Administration (FDA) has approved the following drugs to treat relapsing forms of MS:
Injections
Avonex and Rebif (interferon beta-1a) and Betaseron and Extavia (interferon beta-1b) are injected into the muscle (intramuscular) or under the skin (subcutaneous). It’s believed that these drugs work by controlling inflammation in the central nervous system (CNS).
Copaxone (glatiramer acetate) is a subcutaneous injection that attracts immune-system cells (T cells) that would otherwise attack myelin sheaths.
Glatopa (glatiramer acetate) is considered a generic equivalent of Copaxone.
Kesimpta (ofatumumab) is a self-administered subcutaneous injection that’s taken once a month using a prefilled auto-injector pen. Like Ocrevus, Kesimpta depletes CD20-positive B lymphocytes, a type of white blood cell believed to be involved in the autoimmune process that leads to the development and progression of MS.
Plegridy (peginterferon beta-1a) is a longer-lasting form of interferon.
Oral Medications
Aubagio (teriflunomide) is a once-daily capsule that blocks the production of immune-system cells. Teriflunomide is known from animal studies to cause birth defects. It should be stopped prior to trying to conceive, and it should not be used during pregnancy or breastfeeding.
Bafiertam (monomethyl fumarate) works similarly to Tecfidera and Vumerity and, like them, is taken as a twice-daily capsule.
Gilenya (fingolimod) is a once-daily pill that prevents T cells from getting out of lymph nodes and into the bloodstream. In December 2019, the FDA approved three applications for generic versions of Gilenya. Fingolimod should not be used during pregnancy. It is a known teratogen, meaning it can cause birth defects. In fact, it should be stopped at least two months prior to trying to conceive, and it should not be used during breastfeeding.
Mavenclad (cladribine) is a pill that’s taken in two 10-day courses, one year apart. It works by killing T and B cells, preventing them from damaging the nerves in the brain and spinal cord. Mavenclad is intended for use in people who have already tried and not responded to or tolerated another MS medication. It is not recommended for the treatment of clinically isolated syndrome. Cladribine is known to cause birth defects, and both men and women using the drug should avoid conception for six months following a 10-day course of the drug. Women should refrain from breastfeeding for at least seven days following the last dose.
Mayzent (siponimod) is a pill taken once daily that works similarly to Gilenya. It belongs to the same class of drugs as fingolimod (Gilenya), and while there are no data available regarding the use of siponimod during pregnancy, it is assumed it may have the same effects as fingolimod.
Ponvory (ponesimod) is an oral tablet taken once daily that works similarly to Gilenya, Mayzent, and Zeposia. It belongs to the same class of drugs as fingolimod (Gilenya), and while there are no data available regarding the use of ponesimod during pregnancy, it is assumed it may have the same effects as fingolimod.
Tascenso ODT (fingolimod) is an orally disintegrating tablet that’s taken once daily. The drug is a bioequivalent to Gilenya.
Tecfidera (dimethyl fumarate) is a twice-daily oral capsule that lowers central nervous system inflammation and the ability of immune cells to get into the CNS. A generic version of Tecfidera is available in the United States.
Vumerity (diroximel fumarate) is an oral capsule that’s taken twice daily and that works similarly to Tecfidera, but is believed to cause fewer gastrointestinal side effects than Tecfidera.
Zeposia (ozanimod) is an oral capsule, taken once daily. Zeposia is one of a class of drugs known as S1P receptor modulators, which sequester cells within lymph nodes, thereby preventing them from entering the central nervous system and causing inflammation. Ozanimod belongs to the same class of drugs as fingolimod (Gilenya), and while there are no data available regarding the use of ozanimod during pregnancy, it is assumed it may have the same effects as fingolimod.
Infusions
Briumvi (ublituximab) is a monoclonal antibody designed to target B cells — a type of white blood cell — and reduce their numbers. It’s given as a one-hour IV infusion every six months, following the first dose.
Novantrone (mitoxantrone) is an immunosuppressant drug administered by IV infusion. It requires regular cardiac monitoring, and there is a total maximum amount an individual can receive over their lifetime. Novantrone is not approved to treat clinically isolated syndrome.
Ocrevus (ocrelizumab) is an IV infusion that works by targeting CD20-positive B lymphocytes and destroying them. It’s the only drug approved by the FDA for treating PPMS in addition to relapsing forms of MS.
Tysabri (natalizumab) is an IV infusion that works by binding to white blood cells and interfering with their movement from the bloodstream into the CNS.
Second-Line Therapy for Relapsing MS
The FDA has also approved the IV drug Lemtrada (alemtuzumab) for adults who have either relapsing-remitting MS or active secondary progressive MS and who haven’t responded well to two or more types of disease-modifying medication.
Alemtuzumab works by rapidly depleting the body’s supply of immune (T and B) cells, which temporarily stops the immune-system effects on your CNS and allows your body to create new cells, which might not attack myelin sheaths.
The FDA recommends using it only as a second-line therapy (after other drugs have failed) because it increases the risk of complications, including severe infections, development of new autoimmune diseases, and other potentially dangerous conditions.
Women taking alemtuzumab should wait four months following treatment to try to conceive. The drug should not be administered during pregnancy, and women are cautioned against breastfeeding during treatment with alemtuzumab.
Off-Label RRMS Treatment
The monoclonal antibody Rituxan (rituximab), which is considered a high-efficacy MS treatment, is not approved to treat MS in the United States but is sometimes prescribed off-label to treat relapsing-remitting MS. It is administered intravenously in a healthcare setting.
Rituxan works similarly to Ocrevus, targeting CD20-positive B lymphocytes and destroying them.
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