Table 2.

Summary of Disease-Modifying Therapies Approved for Use in Multiple Sclerosis16,51,105

	Route of Administration	Dose	Principal Proposed Mechanism of Action
Interferon ẞ-1a Interferon ẞ-1b	IM SC SC	30 µg once per week 22–44 µg 3 times per week 0.25 mg every other day	Down-regulation of MHC expression on APCs, decrease pro-inflammatory cytokines, inhibit T-cell proliferation, inhibition of leukocyte migration across the BBB
Glatiramer acetate	SC	20 mg once daily or 40 mg 3 times per week	Shifts pro-inflammatory T-helper-1 lymphocyte to regulatory T-helper2 lymphocyte
Teriflunomide	PO	7–14 mg once daily	Selective reversible inhibition of dihydroorotate dehydrogenase, T-cell activation and cytokine production inhibitor
Dimethyl fumarate	PO	120 mg bid for 1 week then 240 mg bid daily	Decreases pro-inflammatory cytokines and decreases entry of lymphocytes into the CNS (inhibits expression of adhesion molecules)
Fingolimod	PO	0.5 mg once daily	Lymphocyte sequestration in secondary lymphoid tissues
Natalizumab	IV	300 mg every 4 weeks	Interaction with α-integrins preventing lymphocytes from crossing BBB
Cladribine	PO	3.5 mg/kg body weight divided into 2 yearly treatment courses (1–2 tablets/day over 4–5 consecutive days)	Cytotoxic effects on B and T lymphocytes through impairment of DNA synthesis, resulting in long-lasting depletion of lymphocytes
Ocrelizumab (anti-CD20)	IV	Initially 300 mg once repeated after 2 weeks, then 600 mg every 6 months	Anti-CD20 and depletion of B lymphocytes
Mitoxantrone	IV	12 mg/m2 q3m (maximum cumulative dose 140 mg/m2)	Inhibits B cells and T cell and macrophage proliferation
Alemtuzumab	IV	12 mg daily for 5 days, then 1 year later 12 mg daily for 3 days	Anti-CD25 and depletion of lymphocytes

Abbreviations: APC, antigen-presenting cell; BBB, blood–brain barrier; bid, twice a day; CNS, central nervous system; DNA, deoxyribonucleic acid; IM, intramuscular; IV, intravenous; µg, microgram; mg, milligram; MHC, major histocompatibility complex; PO, per oral; SC, subcutaneous.