Table 4.

FDA-Approved Infusion Disease-Modifying Therapies

Infusion Therapies	Dosing	Adverse Effects/Warnings/Precautions
Alemtuzumab43–45	12 mg per d IV for 5 d followed 12 mo later by 12 mg per d IV for 3 d Indication: relapsing forms of MS	Infusion-related reactions (eg, fever, rash, headache, muscle aches) Profound lymphopenia; prophylaxis with antiviral agent is recommended for at least 2 months after the infusions or until CD4 count is > 200 cells/mL due to higher rates of herpes simplex and zoster infections Secondary autoimmunity (eg, thyroid disorders, immune thrombocytopenia, other cytopenias, glomerular nephropathies) Malignancies, including melanoma Pneumonitis Due to the potential risk of secondary autoimmunity, infusion reactions, and malignancies, alemtuzumab is available only through a REMS program Pregnancy Category: C
Mitoxantrone46	12 mg/m2 IV every 3 mo; maximum cumulative dose: 140 mg/m2 Indication: relapsing forms of MS or secondary-progressive MS	Cardiotoxicity (arrhythmia and congestive heart failure) Alopecia Nausea Menstrual disorders, including amenorrhea and infertility Increased risk of URI and UTI infections Bone marrow suppression Secondary acute myelogenous leukemia Pregnancy Category: D
Natalizumab47	300 mg IV every 28 d Indication: relapsing forms of MS	Arthralgia Urticaria Lower threshold for opportunistic infections, including PML, herpes encephalitis, and meningitis Due to the potential risk of PML, natalizumab is available only through a REMS program Pregnancy Category: C

Abbreviations: MS, multiple sclerosis; PML, progressive multifocal leukoencephalopathy; REMS, risk evaluation mitigation strategy; URI, upper respiratory infection; UTI, urinary tract infection.