Home > MS Clinical Care and Research Professionals > Resources to Support Clinical Care > MS Clinical Mgmt > Managing MS > Comprehensive Care > Disease Modification > Mechanisms & Side Effects
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Potential Mechanisms |
Common Adverse Events |
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Interferon b-1a [Avonex] |
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). |
Flu-like symptoms; leukopenia; elevated liver enzymes; thyroid dysfunction
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Interferon b-1a [Rebif] |
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[Betaseron] |
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Interferon b-1b [Extavia] |
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Glatiramer acetate [Copaxone] |
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). |
Injection-site reactions; lipoatrophy; post-injection vasomotor syndrome
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Fingolimod [Gilenya] |
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) |
Headache, flu, diarrhea, back pain, elevated liver enzymes, cough |
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Teriflunomide [Aubagio] |
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. |
Abnormal liver function, alopecia, diarrhea, influenza, nausea and paresthesias |
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[Tecfidera] |
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. |
Flushing, abdominal pain, nausea, diarrhea |
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Natalizumab [Tysabri] |
Binds to alpha4/beta 1 integrin on activated lymphocytes and monocytes; inhibits leukocyte migration across the BBB (Ropper, 2006). |
Hypersensitivity reactions; infusion reactions (headache, rigors) |
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Mitoxantrone [Novantrone] |
Inhibits DNA synthesis; reduces lymphocytes; reduces Th1 cytokines. |
Blue-green urine 24 hours after administration; infections, bone marrow suppression, nausea, hair thinning, bladder infections, mouth sores |