Fast Five Quiz: Relapsing-Remitting Multiple Sclerosis Management

Christopher Luzzio, MD; Kerstin Hellwig, MD


June 30, 2022

Figure 1. Multiple sclerosis is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged.

In 1993, interferon beta-1b became the first medication approved by the FDA to treat RRMS. It reduces the frequency of clinical exacerbations and is therefore indicated for the treatment of relapsing MS. Common adverse reactions of interferon beta-1b are depression, flulike symptoms, increased liver enzyme levels, injection-site reactions, and leukopenia.

DMTs have shown beneficial effects in patients with relapsing MS, including reduced frequency and severity of clinical attacks. These agents appear to slow the progression of disability and reduce accumulation of lesions in the brain and spinal cord. The disease-modifying agents for MS (DMAMS) currently approved for use by the FDA include:

  • Interferons (eg, interferon beta-1a, interferon beta-1b, peginterferon beta-1a)

  • Sphingosine 1-phosphate receptor modulators (eg, siponimod, fingolimod, ozanimod)

  • Monoclonal antibodies (eg, natalizumab, alemtuzumab, ocrelizumab)

  • Miscellaneous immunomodulators (eg, glatiramer, mitoxantrone, teriflunomide, dimethyl fumarate, monomethyl fumarate, cladribine)

The American Academy of Neurology (AAN) and the European Committee of Treatment and Research in Multiple Sclerosis/European Academy of Neurology (ECTRIMS/EAN) offer guidance on the initiation, switching, and stopping of DMTs.

Fingolimod, siponimod, ozanimod, cladribine, teriflunomide, dimethyl fumarate, and monomethyl fumarate are administered orally; natalizumab, ocrelizumab, and mitoxantrone are administered by intravenous infusion; interferon beta-1a is administered intramuscularly; and interferon beta-1a, interferon beta-1b, and glatiramer acetate are administered by subcutaneous injection.

In 2012 and 2013, the FDA approved a single-use autoinjector for self-injection of two interferon beta-1a medications.

Patient lifestyle, patient tolerance, and adverse effects of injections should be considered in the choice of DMAMS.

A case-control study from the MSBase longitudinal cohort found that patients with MS whose disease is well controlled on injectable drugs and who then switch to oral therapies are not at greater risk for early relapse. This is the first study to compare the probability of early relapse in the period immediately after a switch to oral treatment in a population whose disease was previously stable on injectable therapy. Results showed there were no differences in the rate of first relapse or disability progression over the first 6 months.

Learn more about the treatment and management of MS.


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