Fast Five Quiz: Key Aspects of Multiple Sclerosis Treatment

Michelle H. Cameron, MD, PT, MCR; Kerstin Hellwig, MD


June 30, 2022

The monoclonal antibody alemtuzumab was approved by the FDA in November 2014 for relapsing forms of MS. Alemtuzumab is a recombinant monoclonal antibody against CD52 (lymphocyte antigen). This action promotes antibody-dependent cell lysis.

Glatiramer acetate is a synthetic polypeptide approved for reduction in the frequency of relapses in patients with RRMS, including patients who have experienced a first clinical episode and have MRI features consistent with MS. In a double-blind trial that included 251 patients with RRMS, treatment with glatiramer acetate resulted in a 29% reduction in the relapse rate over 2 years. A positive effect on disability progression was suggested, but this effect was not shown on predetermined disability measures in this trial. For this reason, glatiramer acetate is not approved by the FDA for slowing disability progression in MS.

Natalizumab is a humanized monoclonal antibody that binds to the adhesion molecule alpha-4 integrin, inhibiting its adherence to its receptors. Natalizumab is indicated as monotherapy for the treatment of patients with relapsing forms of MS, to delay the accumulation of physical disability and reduce the frequency of clinical exacerbations. It is generally used in patients who have not responded to a first-line DMT or who have very active disease.

The sphingosine 1-phosphate receptor modulator fingolimod is the first oral DMT to be approved by the FDA for relapsing forms of MS. Like other disease-modifying agents for MS, fingolimod can reduce the frequency of clinical exacerbations and delay the accumulation of physical disability. The recommended dosage for fingolimod is 0.5 mg once daily. Fingolimod is contraindicated in patients with recent myocardial infarction, unstable angina, transient ischemic attack, decompensated heart failure requiring hospitalization, or class III/IV heart failure; history or presence of Mobitz type II second- or third-degree AV block or sick-sinus syndrome, unless the patient has a functioning pacemaker; baseline QTc interval greater than or equal to 500 ms; or treatment with class Ia or class III antiarrhythmic drugs.

Learn more about immunomodulatory therapy for RRMS.


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