Treatment Options

Medication Options

• Interferons

  Avonex, Betaseron, Extavia and Rebif are interferon therapies. Interferon is a natural compound that our immune cells make.  Interferon treatment can help “quiet down” inflammatory white blood cells and help block these cells from crossing the blood vessel walls into the brain and spinal cord. Fortunately, this anti-inflammatory benefit does not result in increased infections.
  
  Two interferon beta-1a options are available, Avonex and Rebif. Avonex is given as 30 micrograms in the muscle once a week and Rebif is given as 44 micrograms under the skin three times a week.  Both medications have been shown to prevent relapses, prevent disability and reduce MRI activity.  Avonex reduced relapses by 18-32% in clinical trial. In the patients that finished the two year trial, Avonex prevented the likelihood of disability progression by 37%. Rebif reduced relapses by 32%, reduced new MRI activity by 78%, and prevented the likelihood of disability progression by 30% in clinical trial.  Interferon side effects and risks include low white blood count, rare liver injury, depression, injection reactions and flu-like symptoms that are generally manageable and improve over the first 1-2 months.
  
  In the Evidence trial, patients on Rebif had 17% less relapses and 36% less MRI activity at 64 weeks compared to Avonex. However, 25% of Rebif and 2% of Avonex patients developed antibodies to the interferon which might cause the medication to become less effective. Rebif caused less flu-like symptoms than Avonex, but more liver and white blood count test abnormalities.
  
  Betaseron is a slightly different interferon, interferon beta-1b. Betaseron is given under the skin every other day. Betaseron has also been shown to prevent 34% of relapses and reduce new MRI activity 83%. Trials have also shown that Betaseron reduces the likelihood of becoming disabled when initiated after the first attack and even if secondary progressive with relapses. A head-to-head trial showed benefit of Betaseron over Avonex on relapses, disability and MRI, but the trial was partially limited because both the patients and treating doctors knew which medication the patient was taking ("unblinded"). However, the MRI data was "blinded."

  Extavia is interferon beta-1b.  Interferon beta-1b was the first FDA-approved treatment in 1993.   The version of interferon beta-1b available for the past 16 years has been Betaseron.  Novartis, who temporarily owned the plant making interferon beta-1b,  has made an arrangement with Bayer, makers of Betaseron, to brand and market their version Extavia. 

• Copaxone

  Copaxone (glatiramer acetate) is composed four amino acids, the building blocks of protein. The daily injection therapy is given under the skin. Copaxone increases immune cells that reduce inflammation. In animal models of MS, these cells traveled to the brain and spinal cord to reduce inflammation. In a clinical trial, Copaxone prevented 29% of new attacks and reduced new MRI activity. In recent large trials comparing Copaxone to Rebif and Betaseron, Copaxone showed similar benefits in reduction of relapse rates to these interferons, but benefits on some MRI tests were better for interferon. The side effects of Copaxone include skin injection reactions and occasionally brief chest pain or shortness of breath after injections.

• Tysabri

  Tysabri (natalizumab) is an antibody treatment given in the vein (I.V.) every 4 weeks. Tysabri blocks lymphocytes, a type of white blood cell, from crossing the blood vessel wall to enter the brain or spinal cord. In clinical trial, Tysabri prevented 68% of relapses, reduced new MRI activity by 83%, and slowed the likelihood of progression of disability by 42%. Risks include severe allergic infections and serious infections.

  Out of over 48,000 people being treated with Tysabri as of Feb. 2010, 31 total cases of a rare and untreatable viral brain infection called progressive multifocal leukoencephalopathy (PML) have been associated with use of Tysabri since being available.  The PML cases have occurred on Tysabri after the first year of treatment.

• Novantrone

  Novantrone (mitoxantrone) is a powerful medication given in the vein generally every 3 months for up to 2 years.  The medication has been shown to reduce relapses by 68%, prevent new MRI activity by 85%, and reduce the risk of disability progression by 62%. Although very effective, Novantrone has serious risks including leukemia, heart injury, serious infection and permanent loss of menstrual cycle.   The risk of leukemia varies in studies but may be as much as 1 person in 135 treated patients.