Injectable Medications
| Generic Name | Interferon
Beta-1a |
Interferon
Beta-1a |
Interferon
Beta-1a |
Interferon
Beta-1b |
Glatiramer
acetate |
Glatiramer
acetate |
| Brand Name | Avonex | Plegridy | Rebif | Betaseron Extavia | Copaxone | Glatopa |
| How it is given | IM | SC | SC | SC | SC | SC |
| Frequency | Once a week | Once every 2 weeks | 3 times a week | Every other day | 3 times a week OR daily | Daily |
| Year of FDA approval | 1996 | 2014 | 2002 | 1993 | 1996 | 2015 |
| Mechanism | Modulates immune system* | Modulates immune system* | Modulates immune system* | Modulates immune system* | Modulates immune system* | Modulates immune system* |
| Absolute Reduction in Relapse Rate** | 32% | 36% | 29-32% | 31% | 33% | 33% |
| Tolerability | Flu like sxs, Rare injection site reactions | Flu like sxs Possible injection site reactions | Flu like sxs Possible injection site reactions | Flu like sxs Possible injection site reactions | Possible injection site reactions & possible injection reaction (flushing, heart racing) | Possible injection site reactions & possible injection reaction (flushing, heart racing) |
| Safety | No consistent adverse events reported | No consistent adverse events reported | No consistent adverse events reported | No consistent adverse events reported | No consistent adverse events reported | No consistent adverse events reported |
| Tests required before starting | Yes – LFTs, CBC | Yes – LFTs. CBC | Yes – LFTs, CBC | Yes – LFTs, CBC | No | No |
| Possible blood tests at your visit | LFTs, CBC, TSH | LFTs, CBC, TSH | LFTs, CBC, TSH | LFTs, CBC, TSH | None | None |
| Pregnancy Category | C | C | C | C | B | B |
Oral Medications
| Teriflunomide | Fingolimod | Dimethyl Fumarate | |
| Brand Name | Aubagio | Gilenya | Tecfidera |
| Frequency | Daily | Daily | Twice a day |
| Year FDA Approval | 2012 | 2010 | 2013 |
| Mechanism | Decreases white blood cells | Decreases white blood cells in circulation | Enhances NRF2 free radical scavenge pathway? |
| Absolute Reduction in Relapse Rate** | 31.5% | 52% | 44-53% |
| Tolerability | Diarrhea, nausea, hair loss | Well tolerated | Stomach upset, flushing first month |
| Safety | Potential fetal toxicity, Rare liver function abnormalities | First dose heart slowing, macular edema, PML reported | No significant adverse events in trial, PML reported |
| Tests required before starting | Yes – T Spot for TB, LFTs | Yes – Eye exam and EKG, VZV antibody titer | Yes- LFTs, CBC, lymphocyte count |
| Possible blood tests at your visit | LFTs | LFTs, CBC, lymphocyte count | LFTs, CBC, lymphocyte count |
| Pregnancy Category | X | C | C |
Infusion Medications
| Natalizumab | Rituximab | Ocrelizumab | Alemtuzumab | |
| Brand Name | Tysabri | Rituxan | Ocrevus | Lemtrada |
| Frequency | Once a month | Once every 6 months | Once every 6 months | Once every few years |
| Year FDA Approval | 2004 | 1997 (not FDA approved for MS) | Not yet approved | 2014 |
| Mechanism | Prevents lymphocyte trafficking across BBB | Depletes CD20+ B cells | Depletes CD20+ B cells | Anti CD52–> lymphocyte destruction |
| Absolute Reduction in Relapse Rate** | 68% | 58% | 47% (vs. IFN) | 49.4-54.9% |
| Tolerability | Possible allergic reaction, during infusion | Possible infusion reaction | Possible infusion reaction | Possible infusion reaction |
| Safety | PML risk | Possible serious infection/ possible PML, though never reported in MS pts | No opportunistic infections reported in trials with MS patients | Infusion reactions, thyroid disease, ITP, Goodpasture’s |
| Tests required before starting | Yes- JCV Ab titer | Yes- Hepatitis Panel, CMP, CBC, HIV, RPR, T-spot, SPEP | Yes- Hepatitis Panel, CMP, CBC, HIV, RPR, T-spot, SPEP | Yes – TSH, CMP, CBC, VZV antibody titer |
| Possible blood tests at your visit | JCV Ab titer (checked every 6 months) | CD19/CD20 | CD19/CD20 | TSH, CMP, CBC, UA |
| Pregnancy Category | C | C | Not yet assigned | C |
IM = Intramuscular injection; SC = Subcutaneous injection; LFTs = liver function tests; CBC = Complete Blood Count; WBC = White Blood Cell Count; CMP = complete metabolic panel; TSH = Thyroid stimulating hormone; UA = Urinalysis; sxs = symptoms
* See webpage for more detail on mechanism of action **Based on Phase II/III clinical trials
Partners MS center infusions at the Building for Transformative Medicine Ambulatory Infusion During COVID-19
We have always made patient safety a priority at the Partners MS center. During the COVID-19 pandemic we have made the following adjustments to continue to optimize your safety:
- We have reduced volume intentionally by approximately 1/3 in order to decrease both staff and patient exposure.
- Patient to nurse ratio has been kept the same, typically one nurse will care for two patients
- It has always been a priority to maintain clean facilities and this has continued. All patient bays are being wiped with disinfectant, additional regular rounds of the entire unit are made by both environment services our medical assistants to continue cleaning common and high touch spaces.
- Patients receive a mask when they enter the building. They wear this mask the entire patient treatment.
