Table 2.
MS treatments currently available.
| S.NO | Nameof Drugs | Dose and Route | Adverse Effect | Patients Type | Duration of Treatment | References |
|---|---|---|---|---|---|---|
| 1. | Fingolimod (Peptide) |
0.5 mg p.o. daily | Infections, bradycardia, MS relapse, and basal-cell carcinoma. | RRMS | 6–12 months | [239,240] |
| 2. | Interferon β-1a (Glycoprotein) |
30 mcg (IM), Once a day 22 mcg (SC), TDI |
Flu-like symptoms (fever, chills, sweating, muscleaches, and tiredness), skin reaction, depression, anxiety, and liver problems. |
RRMS | 24 months | [100,241,242] |
| 3. | Interferon β-1a (Glycoprotein) |
22 mg, three injections weekly (SC) |
Fatigue, allergic reactions, flu-like symptoms, emotional instability, trouble breathing, joint problem, eye problems, and hair loss. | RRMS | 6–24 months | [241,243,244] |
| 4. | Interferon β-1b (Non-glycosylated protein) |
0.25 mg (SC) q.o.d., 6 weeks | Leucopenia, flu-like symptoms, elevated hepatic transaminases, injection site reactions, headache, fever, malaise, and myalgia. | RRMS | 24 months | [242,245,246] |
| 5. | Alemtuzumab (Monoclonal antibody) |
12 mg (IV) daily |
Infusion-associated reactions(IARs) include headache, rash, nausea, fever, respiratory tract infection, and thyroid disease. | RRMS | 12 months | [247,248] |
| 6. | Dimethyl Fumarate (Peptide) |
240 mg/kg (p.o.) Twice a day |
Abdominal pain, alopecia, back pain, cough, diarrhea, flushing, headache, influenza, paresthesia, and nausea. | RRMS | 24 weeks | [249] |
| 7. | Glatiramer acetate (peptide) |
20 mg/kg (SC) daily | Post-injection reaction, chest pain, lipoatrophy, and skin necrosis potentially affect the immune response. | RRMS | 24 months | [250,251]. |
| 8. | Dalfampridine (Pyrimidine analogue) |
10 mg/kg twice a day |
Asthenia, insomnia, paresthesia, UTI, dizziness, nausea, peripheral edema, back pain, and nasopharyngitis. | RRMS | 4–24 weeks | [252,253] |
| 9. | Natalizumab (Monoclonal antibody) |
300 mg/kg (i.v.) |
Occurrence of PML, fatal cases of neutralizing antibodies, and PML HSV1/VZV reactivation. | RRMS | ≥12 months | [202,250]. |
| 10. | Ocrelizumab (Monoclonal antibody) |
300 mg/kg (i.v.) |
HSV1/VZV reactivation, HBV hypogammaglobulinemia, and breastcancer PML (carry over). | RRMS | 6 months | [250,254] |
| 11. | Teriflunomide (Enamide) |
14 mg/kg (p.o.) | Hepatic events, lymphopenia, neutropenia, thrombocytopenia, hypertension, pancreatic disorders, hair thinning, and GIT events. | RRMS | 12 weeks | [255,256] |
| 12. | Siponimod (Alkoxyimino) |
0.25–2 mg/kg (p.o.) | Bradycardia, rapid receptor desensitization, decreased absolute lymphocyte count (ALC), lymphopenia, upper respiratory tract infections, pharyngitis, insomnia, and increased alanine aminotransferase. | RRMS | >12 months | [257,258] |
| 13. | Rituximab (Chimeric murine/human monoclonal antibody) |
500–1000 mg (IV) |
Infusion-related adverse events include rash, fatigue, chills, nausea, and general pain. | RRMS | 72 weeks | [259,260] |
| 14. | Mitoxantrone (dihydroxyanthraquinone) |
12 mg/kgbody weight every three months | Mild infections, leucopenia, irreversible amenorrhea, congestive heart failure, alopecia, and asymptomatic systolic dysfunction. | RRMS and SPMS | 2–3 years | [261] |
| 15. | Azathioprine (Purine analogue) | 3 mg/kg daily (p.o.) | GIT disturbance, hepatic toxicity, bone marrow suppression, hepatic toxicity, and increased risk of cancer in MS patients. | RRMS | 6 months | [262] |
| 16. | Methylprednisolone (Corticosteroids) |
500–1000 mg/daily Oral/i.v. |
It may cause interaction with warfarin, reduce the effects of enzyme inducers like anti-epileptic agents, dyspepsia, constipation, euphoria, and altered glucose metabolism. | RRMS | 3–5 days | [263] |
| 17. | Cladribine (Purine antimetabolite) |
3.5 mg/kg (p.o.) two times, 4 or 5 days of treatment each year | Mild renal impairment, hepatic impairment, contraindicated in patients with moderate or severe renal impairment (creatinine clearance < 60 mL/min), and lymphopenia. | RRMS | 2 years | [264,265] |
| 18. | Simvastatin (Statin) |
80 mg/kg, per day (p.o.) | Muscle pain, dizziness, fainting, headache, nausea, and digestive problems. | SPMS | 24 months | [266,267] |
| 19. | Memantine (Amine) |
20 mg/day | Headache, dizziness, agitation, hallucinations, confusion, and diarrhea. | RRMS | 52 weeks | [268,269] |
| 20. | Donepezil (Peptide) |
10 mg/daily (p.o.) | Nausea, diarrhea, headaches, gastroesophageal reflexes, and loss of appetite. | RRMS | 24 weeks | [270,271] |
| 21. | Baclofen (Peptide) |
10–100 mcg intrathecal | Dizziness, drowsiness, headache, weakness, and nausea. | SPMS and PPMS | 4.9 years | [272] |
| 22. | Ublituximab (Monoclonal antibody) |
150–600 mg/kg i.v. infusion |
Infusion-related reactions, nausea, upper respiratory tract infection, arthralgia, hypoesthesia, dizziness, fatigue, and diarrhea. | RRMS and SPMS | 48 weeks | [273] |
| 23. | Ponesimod (Peptide) |
10,20, 40 mg/kg Daily (p.o.) |
Increase alanine aminotransferase, nasopharyngitis, headache, upper respiratory tract infections, and alopecia. | RRMS and SPMS | 24 weeks | [274,275] |
| 24. | Ofatumumab (Monoclonal antibody) |
20 mg/kg (S.C.) |
Headache, nasopharyngitis, urinary tract infections (UTI), upper respiratory infections, and injection-site reactions (pain, itching, erythema, and swelling). | RRMS and SPMS | 12 weeks | [276] |
| 25. | Monomethyl Fumarate (Non-peptide) |
95–190 mg/kg (b.i.d.), orally Delayed release capsule |
Flushing and GI adverse events (abdominal pain, diarrhea, nausea, and vomiting). | RRMS and SPMS | 5 weeks | [277] |
| 26. | Laquinimod (Amide) |
0.3–0.6 mg/kg (p.o.) |
Elevation of liver enzymes, back pain, abdominal pain, cough, dizziness, headache, diarrhea, and respiratory pain. | RRMS and PPMS | 12–24 months | [278,279] |