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Mechanisms & Side Effects

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Interferon b-1a (Avonex)

  • Prescribing Information
  • Potential Mechanisms:
    • Benefits modulated primarily through an anti-inflammatory mechanism
    • Potential effects include down regulation of proinflammatory cytokines, reduced expression of major histocompatibility antigens and decreasing transmigration of T-lymphocytes across the BBB (Bermel & Rudick, 2007)
  • Common Adverse Events:
    • Flu-like symptoms
    • Leukopenia
    • Elevated liver enzymes
    • Thyroid dysfunction

Interferon b-1a (Rebif)

  • Prescribing Information
  • Potential Mechanisms:
    • Benefits modulated primarily through an anti-inflammatory mechanism
    • Potential effects include down regulation of proinflammatory cytokines, reduced expression of major histocompatibility antigens and decreasing transmigration of T-lymphocytes across the BBB (Bermel & Rudick, 2007)
  • Common Adverse Events:
    • Flu-like symptoms
    • Leukopenia
    • Elevated liver enzymes
    • Thyroid dysfunction

Interferon b-1b (Betaseron)

  • Prescribing Information
  • Potential Mechanisms:
    • Benefits modulated primarily through an anti-inflammatory mechanism
    • Potential effects include down regulation of proinflammatory cytokines, reduced expression of major histocompatibility antigens and decreasing transmigration of T-lymphocytes across the BBB (Bermel & Rudick, 2007)
  • Common Adverse Events:
    • Flu-like symptoms
    • Leukopenia
    • Elevated liver enzymes
    • Thyroid dysfunction

Interferon b-1b (Extavia)

  • Prescribing Information
  • Potential Mechanisms:
    • Benefits modulated primarily through an anti-inflammatory mechanism
    • Potential effects include down regulation of proinflammatory cytokines, reduced expression of major histocompatibility antigens and decreasing transmigration of T-lymphocytes across the BBB (Bermel & Rudick, 2007)
  • Common Adverse Events:
    • Flu-like symptoms
    • Leukopenia
    • Elevated liver enzymes
    • Thyroid dysfunction

Glatiramer acetate (Copaxone)

  • Prescribing Information
  • Potential Mechanisms:
    • May promote an anti-inflammatory Th2 shift of T cells in the peripheral circulation, which may be mediated through an inhibitory effect on antigen-presenting cells (Farina et al., 2005).
  • Common Adverse Events:
    • Injection-site reactions
    • Lipoatrophy
    • Post-injection vasomotor syndrome

Fingolimod (Gilenya)

  • Prescribing Information
  • Potential Mechanisms:
    • Binds to a docking site (sphingosine-1-phosphate receptor, or S1P receptor) on immune cells, including T cells and B cells, sequestering some immune cells in the lymph nodes, thereby reducing their availability for cell-mediated immune responses (Horga & Montalban, 2008)
  • Common Adverse Events:
    • Headache
    • Flu
    • Diarrhea
    • Back pain
    • Elevated liver enzymes
    • Cough

Teriflunomide (Aubagio)

  • Prescribing Information
  • Potential Mechanisms:
    • Teriflunomide inhibits a mitochondrial enzyme, dihydroorotate dehydrogenase, which is involved in the de novo pathway of pyrimidine synthesis. This inhibition interferes with DNA synthesis particularly in rapidly dividing cells such as lymphocytes. Reduced lymphocyte activation my lead to the observed immunosuppression and reduced inflammation. An alternate salvage pathway allows pyrimidine synthesis to continue at a reduced rate in resting cells.
  • Common Adverse Events:
    • Abnormal liver function
    • Alopecia
    • Diarrhea
    • Influenza
    • Nausea
    • Paresthesias

Dimethyl fumarate (Tecfidera)

  • Prescribing Information
  • Potential Mechanisms:
    • Mechanism is unknown. Dimethyl fumerate (DMF) and the metabolite, monomethyl fumarate (MMF), have been shown to activate the Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) pathway in vitro and in vivo in animals and humans. The Nrf2 pathway is involved in the cellular  response to oxidative stress. MMF has been identified as a nicotine acid receptor agonist in vitro.
  • Common Adverse Events:
    • Flushing
    • Abdominal pain
    • Nausea
    • Diarrhea

Natalizumab (Tysabri)

  • Prescribing Information
  • Potential Mechanisms:
    • Binds to alpha4/beta 1 integrin on activated lymphocytes and monocytes
    • Inhibits leukocyte migration across the BBB (Ropper, 2006)
  • Common Adverse Events:
    • Hypersensitivity reactions
    • Infusion reactions (headache, rigors)

Mitoxantrone (Novantrone)

  • Prescribing Information
  • Potential Mechanisms:
    • Inhibits DNA synthesis
    • Reduces lymphocytes
    • Reduces Th1 cytokines
  • Common Adverse Events:
    • Blue-green urine 24 hours after administration
    • Infections
    • Bone marrow suppression
    • Nausea
    • Hair thinning
    • Bladder infections
    • Mouth sores

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