Neurology/Multiple sclerosis drugslow yield

Multiple sclerosis drugs

also: methylprednisolone relapse · beta-interferon · natalizumab · baclofen

Overview

Treatment of MS across relapse, disease modification and symptom control.

Mechanism

Acute relapse: high-dose corticosteroid shortens the relapse (does not change long-term course). DMTs are immunomodulatory/immunosuppressive (reduce relapse rate). Symptomatic drugs target the consequences (baclofen → GABA-B for spasticity).

Indications

Acute MS relapse
Relapsing-remitting MS (disease-modifying therapy)
MS symptoms (spasticity, bladder, fatigue)

The agents

Methylprednisoloneacute relapse

high-dose IV/oral

Shortens relapse only.

DMTs (beta-interferon, dimethyl fumarate, natalizumab, ocrelizumab, fingolimod)disease-modifying

specialist

Natalizumab: PML risk (JC virus); escalate by activity.

Baclofen / gabapentin (spasticity); oxybutynin (bladder); amantadine (fatigue)symptomatic

Symptom control.

Adverse effects

DMT immunosuppression / infectionserious

Natalizumab: progressive multifocal leukoencephalopathy (PML)serious

Steroid effects (relapse courses)common

Cautions & contraindications

Live vaccines on strong immunosuppressive DMTsall

Interactions

DMT-specific

Monitoring & kinetics

JC virus serology (natalizumab); relapse rate/MRI; specialist

Steroids for relapse; DMTs SC/IV/oral (specialist).

Source: NICE NG220 — Multiple sclerosis · BNF — MS