Which drug can be used in all stages of MS?
Ocrevus
What are the 5 interferons, and in which stages are interferons used?
Interferons are indicated for CIS, RRMS and active SPMS disease, and they are:
- Betaseron (SQ)
- Rebif (SQ)
- Avonex (IM)
- Plegridy (SQ)
- Extavia (SQ)
Which two DMTs are not used in CIS, due to their side effect profiles?
- Lemtrada
- (BBW:fatal AI, IR, stroke, malignancy)
- REMS med
- Mavenclad (BBW: malignancy, teratogenic)
What are the 3 sphingosine 1-phosphate receptor modulators used in CIS, RRMS and/or active SPMS?
- Mayzent
- Gilenya
- Zeposia
Which medication is used in chronic SPMS and worsening RRMS?
Novantrone (mitoxantrone), and it has BBWs:
- cardiotoxic, CHF
- LVEF
- secondary AML
- IV by experienced physician only
- BMS (do not give if neutrophils <1500/mm3 (exc. in nonlymphocytic leukemia)
Which DMTs are believed to activate the Nrf2 pathway?
- Tecfidera, take with fat/protein
- Vumerity, limit fat/calorie intake, increased risk of HZV and opportunistic infections
both are po bid, have a risk of PML, flushing, NVD, elevated liver enzymes
Which DMT inhibits dihydroorotate dehydrogenase and has a BBW for hepatotoxicity and embryolethality?
Aubagio (teroflunamide), and it is contraindicated in hepatic impairment, pregnancy, leflunomide co-administration and hypersensitivity
Which 3 DMTs are S1P receptor modulators and what are some unique facts about each?
- Gilenya (1, 3, 4 & 5), increase in disability after stopping, PRES, CI: QTc >500msec, antiarrhythmics
- Zeposia (1 & 5), retitrate if dose is missed in first 2 weeks, CI in sleep apnea
- Mayzent (1 & 5), contraindicated in CYP2C9*3/3 genotype
Which 3 DMTs are the same drug that is injected subq, and contraindicated for people with a hypersensivity to mannitol?
- glatiramer acetate
- Glotopa
- Copaxone
Which DMT is only available through the TOUCH prescribing program?
Tysabri, binds the a-4b1 and a-4b7 integrins from adhering to the endothelial receptor. 300mg IV over 1 hour every 4 weeks.
Which DMTs are administered intravenously?
- Lemtrada (REMS)
- Novantrone
- Ocrevus
- Tysabri (REMS)
Which DMT is administered IM?
Avonex
Which DMTs are administered subq?
- Betaseron and Extavia
- Copaxone, Glatopa and Glatiramer Acetate
- Plegridy
- Rebif
Which DMTs are taken by mouth?
- tabs
- Ampyra-BID
- Aubagio-QD
- Mavenclad
- Mayzent-CYP2C9 dose
- caps
- Gilenya-QD
- Zeposia-LD, then QD
- Tecfidera-LD then BID
- Vumerity-LD then BID
Which perenteral DMTs are stable at excursion (15-30ºC or 59-86ºF) and controlled room (20-25ºC or 68-77ºF) temperatures?
- Betaseron and Extavia
- Novantrone
Which unopened bottle of tablets needs refrigeration (2-8ºC/36-46ºF) to maintain stability?
Mayzent; once opened, stability is maintained at controlled room temperature (20-25ºC/68-77ºF)
Which DMTs need to be handled with gloves?
- Aubagio
- Gilenya
- Mayzent
- Mavenclad needs to be handled with dry hands, but hands and surfaces need to be washed afterwards
Which non-DMT has an increased risk of seizures when coadministered with metformin, cimetidine, or other OCT2 inhibitors?
Ampyra
