Table 2.
DMTs in the treatment of MS
| DMTs recommended for pwMS with moderate disease activity, 1st choice in escalation | dose and route of administration |
|---|---|
|
interferon-beta-1b (Betaferon) interferon-beta-1a (Avonex) interferon-beta-1a (Rebif) PEG-interferon-beta-1a (Plegridy) |
8 MIU s.c. every other day 30 ug i.m./week 44 ug s.c. 3 times/week 125 ug s.c. / 2 weeks |
|
glatiramer acetate (Copaxone) |
40 mg s.c. 3 times/week |
|
teriflunomide (Aubagio) |
14 mg/day |
|
dimethyl fumarate (Tecfidera) |
1st week 2 × 120 mg from the 2nd week 2 × 240 mg |
| diroximel fumarate (Vumerity) |
1st week 2 × 231 mg from the 2nd week 2 × 462 mg |
| DMTs recommended for pwMS with high disease activity for escalation or as 1st choice* | dose and route of administration |
| fingolimod (Gilenya) | 0.5 mg/day |
| siponimod (Mayzent) |
Depending on the CYP2C9 genotype: Genotypes *1/*1, *1/2 or *2/*2 Days 1–2: 0.25 mg Day 3: 0.5 mg Day 4: 0.75 mg, then 1 mg/day |
| ozanomid (Zeposia) |
Day 1–4: 0.23 mg Day 5–7: 0.46 mg, then 0.92 mg/day |
| ponezimod (Ponvory) |
Days 1–2: 2 mg Days 3–4: 3 mg Days 5–6: 4 mg Day 7: 5 mg Day 8: 6 mg Day 9: 7 mg. Day 10: 8 mg Day 11: 9 mg, Day 12-14: 10mg, then 20mg/day |
| cladribine (Mavenclad) |
3.5 mg/kg divided into 2 yearly courses 1 course = 2 cycles of 4-5days 23–27 days apart |
| natalizumab (Tysabri) |
300 mg i.v./month or also available in 2 × 150 mg s.c./ month |
| alemtuzumab (Lemtrada) |
2 cycles 12 months apart 1st cycle: 12 mg i.v. for 5 days 2nd cycle: 12 mg i.v. for 3 days |
| ocrelizumab (Ocrevus) | Day 1 and 15: 300 mg i.v., than every 6 months 600 mg i.v. |
| ofatumumab (Kesimpta) |
20 mg s.c. Induction: Day 1, 7 and 14: 20 mg s.c., than every 4 weeks 20 mg s.c. |
*Monoclonal antibody therapies (natalizumab, alemtuzumab, ocrelizumab and ofatumumab) are the most efficient DMTs. (based on the SmPCs of subsequent DMTs)
abbreviations: i.m. – intramuscular, i.v. – intravenous, s.c. – subcutaneous