Your Guide to Disease Modifying Therapies

MS DMTs Taken by Mouth

Teriflunomide

Aubagio® (click to learn more)

• Administration & Dosage: Aubagio is an MS DMT that is given daily by mouth. 

• Mechanism of Action: Aubagio is thought to work in MS by blocking an enzyme needed for the function of specific T and B lymphocytes that contribute to MS inflammation and damage. 
• Approval: Aubagio was approved by the U.S. Food and Drug Administration (FDA) for the treatment of patients with relapsing forms of multiple sclerosis in adults, including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease. 

Oral Fumarates

| Bafiertam® | Dimethyl Fumarate | Tecfidera® | Vumerity® | (click to learn more) 

• Administration & Dosage: Oral fumarate medications are taken by mouth twice daily. All oral fumarate medications work similarly, but there are differences in the chemical formulations and side effects. 
• Mechanism of Action: Oral fumarates are a class of MS DMTs that are thought to work in MS by activating a central nervous system pathway that helps limit inflammation and damage.  

• Approval: Each oral fumarate medication is FDA-approved for treating relapsing forms of multiple sclerosis (MS) in adults, including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease in adults. 

S1P Receptor Modulators

| Gilenya® | Mayzent® | Ponvory® | Zeposia® | (click to learn more)

• Administration & Dosage: S1P receptor modulators are a class of MS medications taken once or twice daily (depending on the specific medication) by mouth. They work similarly, but there are differences in dosing, drug metabolism, and first-dose monitoring. 
• Mechanism of Action: S1P receptor modulators are thought to work in MS by keeping certain types of lymphocytes (white blood cells that contribute to MS inflammation and damage) in the lymph organs, preventing them from circulating, entering the CNS, and contributing to MS inflammation and damage. 
• Approval: S1P receptor modulators are each FDA-approved for relapsing forms of multiple sclerosis, which include clinically isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease (SPMS with relapses). Gilenya® is also approved for use in children ages ten and up. 

Cladribine

Mavenclad® (click to learn more)

• Administration & Dosage: Mavenclad is an MS treatment taken daily by mouth on a specific intermittent schedule that occurs over two years.  
• Mechanism of Action: Mavenclad is thought to work in MS by temporarily reducing the number of both T and B lymphocytes (white blood cells that are part of the immune system) so there are fewer cells to contribute to MS inflammation and damage. Mavenclad does not permanently or continuously suppress the immune system. 
• Approval: Mavenclad is FDA-approved to treat relapsing forms of multiple sclerosis (MS) in adults, including relapsing-remitting disease and active secondary progressive disease. Because of its safety profile, MAVENCLAD is generally used in people who have tried another MS medicine that they could not tolerate or that has not worked well.  
• Considerations to note: Mavenclad may cause birth defects if taken during pregnancy. Females must not be pregnant when they start treatment with Mavenclad or become pregnant during Mavenclad dosing and within six months after the last dose of each yearly treatment course. 

Self-injected MS DMTs

Interferons

| Betaseron® | Extavia® | Plegridy® | Rebif® | (click to learn more)

• Administration & Dosage: Interferons are DMTs that are given by self-injection – either under the skin (subcutaneously) or intramuscularly (into a muscle). Each is given by a different schedule (every other day, three times a week, weekly, or every 14 days).
• Mechanism of Action: Interferons are a class of drug that are thought to work in MS by reducing the inflammatory response that occurs in MS.
• Approval: Each of the interferon medications is FDA-approved for the treatment of relapsing forms of multiple sclerosis (MS) in adults, including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease.

Glatiramer Acetate

| Copaxone® | Glatopa® | Glatiramer Acetate Injection | (click to learn more)

• Administration & Dosage: Glatiramer acetate is a class of drug that is given by self-injection under the skin every day or three times per week, depending on the specific formulation. 
• Mechanism of Action: Glatiramer acetate is thought to work in MS by inducing immune system cells that reduce inflammatory activity in the CNS. 
• Approval: Glatiramer acetate medications are each FDA-approved for treating relapsing forms of multiple sclerosis (MS) in adults, including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease. 

Ofatumumab

Kesimpta® (click to learn more)

• Administration & Dosage: Kesimpta is given by self-injection every 4 weeks after a starting dose regimen given weekly for 3 doses. 
• Mechanism of Action: Kesimpta is thought to work in MS by depleting the population of B cells, which are a type of lymphocyte (white blood cell) that contribute to MS inflammation. 
• Approval: Kesimpta is FDA-approved for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults. 

MS DMTs Given by IV Infusion

Alemtuzumab

Lemtrada® (click to learn more)

• Administration & Dosage: Lemtrada is an MS medication given by intravenous infusion (IV) into a vein. It is given by daily infusion for five days in year one, then daily for three days one year after the first round of infusions. Some people may receive a 3rd round of infusions one year after the second round. 
• Mechanism of Action: Lemtrada is thought to work in MS by depleting T and B lymphocytes, which are white blood cells that contribute to the inflammation and damage in MS. 
• Approval: Lemtrada is FDA-approved for treating relapsing forms of multiple sclerosis (MS), including relapsing-remitting disease and active secondary progressive disease, in adults.
• Considerations to Note: Due to its safety profile, the use of LEMTRADA should generally be reserved for patients who have had an inadequate response to two or more drugs indicated for treating MS. 

Ublituximab

Briumvi® (click to learn more)

• Administration & Dosage: Briumvi is an MS medication given by intravenous infusion (IV) over approximately one hour, into a vein every six months following a starting regimen of 150 mg IV on day 1 and 450 mg IV on day 15
• Mechanism of Action: Briumvi is thought to work in MS by depleting the number of B cells, which are a type of lymphocyte (white blood cell) that contribute to MS inflammation and damage. 
• Approval: Briumvi is approved by the FDA for the treatment of relapsing forms of multiple sclerosis in adults, which include clinically isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease (SPMS with relapses) in adults.

Ocrelizumab

Ocrevus® (click to learn more)

• Administration & Dosage: Ocrevus is an MS medication given by intravenous infusion (IV) into a vein every six months following a starting regimen of two ½ dose infusions separated by two weeks. 
• Mechanism of Action: Ocrevus is thought to work in MS by depleting the number of B cells, which are a type of lymphocyte (white blood cell) that contribute to MS inflammation. 
• Approval:  Ocrevus is approved by the FDA for the treatment of relapsing forms of multiple sclerosis in adults, which include clinically isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease (SPMS with relapses). The FDA also approves Ocrevus to treat primary progressive MS in adults. 

Natalizumab

| Tysabri® | Tyruko® | (click to learn more)

• Administration & Dosage: Natalizumab is an MS medication given by intravenous infusion (IV) into a vein every 28 days 

• Mechanism of Action: Natalizumab is thought to work in MS by blocking the entry of certain immune cells into the central nervous system, thereby reducing their ability to contribute to MS inflammation and damage 
• Approval: Natalizumab is FDA-approved as a monotherapy (not given with other MS DMTs) for the treatment of relapsing forms of multiple sclerosis, including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.  
• Considerations to Note: Tyruko is a natalizumab biosimilar that has recently gained FDA approval. It is expected to be made available in late 2024. For a better understanding of biosimilars and generics, click here.