Table 3.
List of FDA-approved disease-modifying therapies to treat multiple sclerosis, adapted from [128, 129, 188, 189].
| Drug | Route of administration | Drug class | Mechanism of action | Treatment strategy | Main possible side effects when compared to placebo | Approved indication |
|---|---|---|---|---|---|---|
| Interferon beta-1a | Injection | Protein biologic | Immunomodulatory | First line | Injection site reaction, influenza-like symptoms, lymphopenia, depression | RRMS |
| Interferon beta-1b | Injection | Protein biologic | Immunomodulatory | First line | Injection site reaction, influenza-like symptoms, lymphopenia, depression | RRMS |
| Glatiramer acetate | Injection | Peptide polymer | Immunomodulatory | First line | Injection site reactions, vasodilatation, rash, dyspnea, chest pain | RRMS |
| Teriflunomide | Oral | Small molecule | Immune suppressive | First line | Hepatotoxicity, alopecia, diarrhea, influenza, nausea, and paresthesia | RRMS |
| Fingolimod | Oral | Small molecule | Immunomodulatory | First line | Headache, liver transaminase elevation, diarrhea, cough, influenza, sinusitis, pain | RRMS |
| Dimethyl fumarate | Oral | Small molecule | Immunomodulatory | First line | Flushing, abdominal pain, diarrhea, nausea | RRMS |
| Cladribine | Oral | Small molecule | Immune suppressive | First or second line | Upper respiratory tract infection, headache, lymphopenia | RRMS, SPMS |
| Siponimod | Oral | Small molecule | Immunomodulatory | First line | Headache, hypertension, transaminase increases | RRMS, SPMS |
| Alemtuzumab | Infusion | Humanized mAb | Immune suppressive | Second or third line | Infusion reactions, infections, rash, headache, pyrexia | RRMS |
| Mitoxantrone | Infusion | Small molecule | Immune suppressive | Second or third line | Nausea, alopecia, urinary tract infection, cardiotoxicity, menstrual disorders | RRMS, SPMS |
| Ocrelizumab | Infusion | Humanized mAb | Immune suppressive | First or second line | Infusion reactions, skin and respiratory tract infections | RRMM, PPMS |
| Natalizumab | Infusion | Humanized mAb | Inhibits immune cell trafficking into CNS | Second line | Delayed infusion reactions, progressive multifocal leukoencephalopathy (PML), hypersensitivity, immunosuppression/infections, headache, fatigue | RRMS |