Table 1 — Approved DMTs in the United States1

    Medication  

Route of Administration & Dosing Frequency


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Comments/Evidence

Interferon beta
Interferon beta-1a
&
Interferon beta-1b (4 drugs)

• SC, IM (self-injectable)
• Every other day to weekly
• Every 2 weeks for pegylated interferon beta-1a

• First-line therapy
• Approved for CIS and delay clinical and/or MRI conversion to MS
• High dose formulations: superior for relapse control and MRI effects; no effect on disability outcomes
• Decreased adherence with greater injection frequency
   o Pegylated formulation has similar efficacy and possibly increased adherence

Glatiramer acetate (2 drugs)

• SC (self-injectable)
• Daily or three times weekly

• Reduces ARR and has benefits on MRI outcomes; no effects on disability progression
• 20mg preparation: first generic DMT approved (2015)

Daclizumab

• SC (self-injectable)
• Every 4 weeks

• Indicated in patients with inadequate response to 2 or more MS agents
• Superior to IM interferon beta-1a in reducing ARR and improving MRI outcomes, but not risk of progression

Fingolimod

• Oral
• Daily

• First-line therapy
• Reduces ARR; mixed evidence on risk of disability progression and benefits on MRI outcomes
• Contraindicated in patients with cardiac disorders, certain antiarrhythmics, symptomatic cerebrovascular disease
• Ophthalmological monitoring required to detect macular edema

Teriflunomide

• Oral
• Daily

• First-line therapy
• Both doses (7mg, 14mg): reduce ARR, show benefit for treatment of CIS
• 14mg dose: reduces disability progression and risk of progression; has greater MRI benefits
• Black box warnings: hepatotoxicity
• Teratogenic: reproductive counseling necessary for women and men

Dimethyl fumarate

• Oral
• Daily

• First-line therapy
• Reduces ARR and risk of disability

Natalizumab

• IV
• Every 28 days

• Typically used as later line therapy
• Reduces ARR and risk of disability progression; has benefits on several MRI outcomes
• Benefits on clinical outcomes in patients with breakthrough attacks despite IM interferon beta-1a treatment (one study)

Alemtuzumab

• IV
• Five infusions year 1 and three infusions year 2

• Typically used second or later line for breakthrough relapsing disease; can be considered first-line for highly active treatment-naïve MS
• CARE-MS I study: reduction in ARR but not EDSS progression
• CARE-MS II study: reduction in ARR and sustained disability progression, benefit on all MRI variables versus interferon beta-1a
• Extension studies: many patients remain relapse-free for up to 5 years

Mitoxantrone

• IV
• Every 3 months for maximum of 2 years

• Approved for worsening relapse MS or SPMS
• Rarely used due to AEs

Abbreviations: AEs – adverse events; CIS – clinically isolated syndrome; EDSS – Extended Disability Status Scale; IM – intramuscular; IV – intravenous; SC – subcutaneous