Natalizumab (Tysabri®) Natalizumab (Tysabri®) is a drug approved by the FDA to treat relapsing multiple sclerosis.The safety and efficacy of natalizumab beyond two years are unknown.The reaction may involve flushing, chest pain or tightness, palpitations, anxiety, shortness of breath, tightness in the throat, or hives.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 an alternate multiple sclerosis therapy.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.Mitoxantrone is a chemotherapy drug that carries the risk of serious cardiac side effects or cancer (leukemia).The reaction usually resolves within 30 minutes and requires no treatment.The most common side effects of fingolimod are headache, flu, diarrhea, back pain, elevations of liver enzymes in the blood, and cough.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 or diminished by glatiramer acetate.Natalizumab is a monoclonal antibody against VLA-4, a molecule required for immune cells to adhere to other cells, and penetrate into the brain.Mitoxantrone (Novantrone®) Mitoxantrone (Novantrone®) is approved by the FDA for the treatment of multiple sclerosis (SP-MS, PR-MS, and worsening RR-MS).Glatiramer acetate (Copaxone) Glatiramer acetate (Copaxone) is another DMD that is approved for reducing the frequency of relapses in RR-MS.Other side effects are also possible including eye problems, so those taking this drug should have regular ophthalmologic evaluations.A reaction occurring immediately after the injection of glatiramer acetate is common, affecting one out of 10 patients.It is administered via monthly intravenous infusions.For this reason only patients who have signed up for treatment under a controlled drug distribution program can receive treatment with natalizumab.Although the exact mechanism of action of fingolimod is unclear, it appears to work by reducing the number of lymphocytes (a type of white blood cell that is important for immunity and the inflammation process) in the blood.Like many injectable therapies for MS, the long-term safety of fingolimod is unknown.Fingolimod (Gilenya®) Fingolimod (Gilenya®) is a daily oral medication to treat MS that was approved by the US FDA in September 2010 as the first oral medication to treat MS.It is not a cure for MS, but it has been shown to decrease the number of MS flares and slow down the development of physical disability caused by MS.
Fingolimod is taken daily in capsule form.Cardiac monitoring prior to each dose and yearly following the last dose of mitoxantrone also is necessary.Mitoxantrone is not used in the treatment of patients with PP-MS.The risk of PML may increase with prolonged exposure to natalizumab.Some patients may be at risk of developing lipoatrophy, inflammation and destruction of fat tissue beneath the skin at the site of injection.Mitoxantrone is used for reducing neurologic disability and/or the frequency of clinical relapses in patients with SP-MS, PR-MS, or worsening RR-MS (for example, patients whose neurologic status is significantly abnormal between relapses).Natalizumab is used alone 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.Because of these serious side effects, physicians tend to reserve its use for more advanced or worsening cases of multiple sclerosis, and there is a limit to the total amount of mitoxantrone that can be administered.