25. Top 10 Multiple Sclerosis Drugs

• #10. Extavia (interferon beta-1b)

  Sponsor/Developer: Novartis

  Dosage strength, form, and frequency: Recommended dose is 0.25 mg injected subcutaneously every other day. Generally, start at .0625 mg (0.25 mL) subcutaneously every other day, and increase over a six week period to 0.25 mg (1 mL) every other day

  Mechanism of action: Unknown

  Indication: Relapsing forms of MS to reduce the frequency of clinical exacerbations

  2013 sales: $159 million

• #9. Aubagio (teriflunomide)

  Sponsor/Developer: Genzyme (Sanofi)

  Dosage strength, form, and frequency: 7 mg and 14 mg tablets, once-daily, with or without food

  Mechanism of action: Pyrimidine synthesis inhibitor

  Indication: Relapsing forms of MS

  2013 sales: About $226 million (€166 million)¹

• #8. Ampyra (dalfampridine) / Fampyra

  Sponsor/Developer: Acorda Therapeutics and Biogen Idec

  Dosage form and strength: 10 mg tablets

  Mechanism of action: Potassium channel blocker

  Indication: Improve walking in patients with MS

  2013 sales: $302.301 million²

• #7. Rebif (interferon beta-1a)

  Sponsor/Developer: EMD Serono and Pfizer

  Dosage strength, form, and frequency: 22 mcg and 44 mcg by injection three times per week. Rebif should be administered, if possible, at the same time (preferably late afternoon or evening) on the same three days, at least 48 hours apart each week. Generally, patients should be started at 20% of the prescribed dose three times per week and increased over a four-week period to the targeted dose, either 22 or 44 mcg three times per week

  Mechanism of action: Unknown

  Indication: Relapsing forms of MS, to decrease the frequency of clinical exacerbations and delay the accumulation of physical disability.

  2013 Sales: About $622 million (€460 million) through September 30, 2013^3,4

• #6. Tecfidera (dimethyl fumarate)

  Sponsor/Developer: Biogen Idec

  Dosage strength, form, and frequency: Starting dose: 120 mg twice a day, orally, for seven days, followed by maintenance dose after seven days: 240 mg twice a day, orally. Capsules must be swallowed whole and intact. Tecfidera can be taken with or without food.

  Mechanism of action: Unknown

  Indication: Relapsing forms of MS

  2013 Sales: $876 million
• • #5. Betaseron (Betaferon; Interferon beta-1b)

    Sponsor/Developer: Bayer HealthCare

    Dosage strength, form, and frequency: Recommended dose is 0.25 mg via injection every other day. Generally, patients are advised to start at 0.0625 mg (0.25 mL) via injection every other day, and increase over a six-week period to 0.25 mg (1 mL) every other day

    Mechanism of action: Unknown

    Indication: Relapsing forms of MS, to reduce the frequency of clinical exacerbations

    2013 sales: $1.05 billion (€779 million) as of September 30, 2013⁵

  • #4. Tysabri (natalizumab)

    Sponsor/Developer: Biogen Idec⁶

    Dosage strength, form, and frequency: 300 mg infused intravenously over approximately one hour, every four weeks

    Mechanism of action: Binds to the α4-subunit of α4β1 and α4β7 integrins expressed on the surface of all leukocytes except neutrophils, and inhibits the α4-mediated adhesion of leukocytes to their counter-receptor(s).

    Indication: Adults with relapsing forms of MS

    2013 sales: $1.67 billion⁷

  • #3. Gilenya (fingolimod)

    Sponsor/Developer: Novartis

    Dosage strength, form, and frequency: Recommended dose: 0.5 mg orally once daily, with or without food

    Mechanism of action: Metabolized into Fingolimod-phosphate, a sphingosine 1-phosphate receptor modulator that binds with high affinity to sphingosine 1-phosphate receptors 1, 3, 4, and 5. Fingolimod-phosphate blocks the capacity of lymphocytes to egress from lymph nodes, reducing the number of lymphocytes in peripheral blood. The mechanism of action on MS is unknown but may involve reduction of lymphocyte migration into the central nervous system.

    Indication: Relapsing forms of MS, to reduce the frequency of clinical exacerbations and to delay the accumulation of physical disability

    2013 sales: $1.9 billion

  • #2. Avonex (interferon beta-1a)

    Sponsor/Developer: Biogen Idec

    Dosage strength, form, and frequency: 30 micrograms once a week is recommended. To reduce the incidence and severity of flu-like symptoms that may occur when initiating Avonex therapy at a dose of 30 micrograms, Avonex may be started at a dose of 7.5 micrograms and the dose may be increased by 7.5 micrograms each week for the next three weeks until the recommended dose of 30 micrograms is achieved.

    Mechanism of action: Unknown

    Indication: Relapsing forms of MS, to slow the accumulation of physical disability and decrease the frequency of clinical exacerbations

    2013 Sales: $3 billion⁸

  • #1. Copaxone (glatiramer acetate)

    Sponsor/Developer: Teva

    Dosage strength, form, and frequency: 20 mg/mL daily by injection; 40 mg/mL three times per week by injection (9)

    Mechanism of action: Not fully understood; believed to act by modifying immune processes that are believed to be responsible for the pathogenesis of MS.

    Indication: Relapsing forms of MS

    2013 sales: $4.328 billion