Multiple Sclerosis (cont.)
Other medications
Glatiramer acetate
Glatiramer acetate (Copaxone) is another disease-modifying drug that is approved for reducing the frequency of relapses in RR-MS. Glatiramer acetate is a synthetic (man-made) amino acid mixture that may resemble a protein component of myelin. It is thought that the immune system reaction against myelin in
multiple sclerosis may be blocked by glatiramer acetate. A reaction occurring immediately after the injection of glatiramer acetate is common, affecting
one out of 10 patients. The reaction may involve flushing,
chest pain or tightness,
palpitations, anxiety,
shortness of breath, tightness in the throat, or hives. The reaction usually resolves within 30 minutes and requires no treatment. Some patients may be at risk of developing lipoatrophy, inflammation and destruction of tissue beneath the skin at the site of injection. Glatiramer acetate is used for reducing the frequency of relapses in patients with relapsing-remitting multiple sclerosis.
Natalizumab
Natalizumab (Tysabri®) is a drug approved by the FDA to treat
multiple sclerosis. Natalizumab is a monoclonal antibody against VLA-4, a molecule required for immune cells to adhere to other cells, penetrate the blood brain barrier and enter the brain. It is administered via monthly intravenous infusions. It carries a warning for a potentially fatal disease, progressive multifocal leukoencephalopathy (PML), a viral infection of the brain that usually leads to death or severe disability. For this reason only patients who have signed up for treatment under a controlled drug distribution program can get this treatment.
Natalizumab is used as monotherapy for the treatment of patients with relapsing forms of
multiple sclerosis to delay the progression of physical disability and reduce the frequency of clinical relapses. The safety and efficacy of natalizumab beyond two years are unknown. Because natalizumab increases the risk of PML, it is generally recommended only for patients who have had an inadequate response to, or are unable to tolerate alternate
multiple sclerosis therapies.
Mitoxantrone
Mitoxantrone (Novantrone®) is also approved by the FDA for the treatment of
multiple sclerosis. Mitoxantrone is a chemotherapy drug that carries the risk of serious cardiac side effects or cancer. Because of these serious side effects, physicians tend to reserve its use for more advanced or worsening cases of multiple sclerosis.
Mitoxantrone is used for reducing neurologic disability and/or the frequency of clinical relapses in patients with secondary (chronic) progressive, progressive relapsing, or worsening relapsing-remitting multiple sclerosis (for
example, patients whose neurologic status is significantly abnormal between relapses).
Mitoxantrone is not used in the treatment of patients with primary progressive multiple sclerosis.
Next: How are the manifestations of multiple sclerosis treated? »
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