Multiple Sclerosis (MS) is a chronic neurological condition affecting the brain and spinal cord, disrupting communication between the brain and the rest of the body. This disruption leads to a range of unpredictable symptoms. Biogen, a leading pharmaceutical company, has developed treatments for MS for several decades. Their therapies are designed to slow disease progression and reduce the frequency of relapses.
Key Biogen MS Medications and Their Actions
Biogen offers several disease-modifying therapies (DMTs) for MS. Each works through different mechanisms to reduce inflammation and protect nerve cells within the central nervous system.
Tecfidera (dimethyl fumarate) is an oral medication approved for relapsing forms of MS. It is thought to activate the nuclear factor (erythroid-derived 2)-like 2 (Nrf2) pathway, which helps defend cells against oxidative stress. Tecfidera may also reduce immune system activation by binding to proteins on the surface of T-cells.
Vumerity (diroximel fumarate) is another oral medication for relapsing forms of MS. Diroximel fumarate is rapidly converted in the body to monomethyl fumarate (MMF), the same active metabolite as Tecfidera. Vumerity modulates the immune system to reduce inflammation and activates the Nrf2 pathway. It also activates hydroxycarboxylic acid receptor 2 (HCAR2), leading to anti-inflammatory activity in immune cells.
Tysabri (natalizumab) is an intravenous infusion approved for relapsing forms of MS, including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease. This medication is a humanized monoclonal antibody that selectively binds to alpha-4 integrin on white blood cells. By blocking these adhesion molecules, Tysabri prevents inflammatory cells from crossing the blood-brain barrier and entering the central nervous system, reducing nerve damage.
Plegridy (peginterferon beta-1a) is an injectable medication for relapsing forms of MS. It is thought to bind to type I interferon receptors on cell surfaces, regulating interferon-responsive gene expression. This action modulates immune activity and reduces inflammation. Plegridy is a pegylated form of interferon beta-1a, modified to last longer in the body for less frequent dosing.
Avonex (interferon beta-1a) is an intramuscular injection used for relapsing forms of MS. Like Plegridy, Avonex contains interferon beta-1a. It is believed to calm the immune system and reduce inflammatory damage in the brain and spinal cord, decreasing relapse frequency.
Administration and Monitoring of Biogen MS Drugs
Biogen MS medications are administered in various ways, including oral, injectable, and intravenous infusion.
Oral medications, such as Tecfidera and Vumerity, are capsules taken by mouth, typically twice a day. This offers convenience for patients, as it can be taken at home.
Injectable treatments, including Plegridy and Avonex, are administered either subcutaneously or intramuscularly. Plegridy is usually given once every two weeks, while Avonex is typically administered once weekly. Patients or caregivers can learn to self-administer these injections after training.
Intravenous infusions, like Tysabri, are given directly into a vein by a healthcare professional in a hospital or infusion center. These infusions generally take a few hours and are typically administered once every four weeks.
Regular monitoring is part of managing MS treatment to ensure safety and effectiveness. This includes periodic blood tests for liver function, complete blood counts (CBC), and white blood cell counts. For some medications, specific tests like JCV (John Cunningham virus) antibody testing are performed, as this virus can increase the risk of a rare brain infection. MRI scans of the brain are also regularly conducted to detect new or changing brain lesions, helping healthcare providers assess disease activity.
Potential Side Effects and Management
Like all medications, Biogen MS drugs can have side effects, which vary depending on the specific drug and individual patient response.
Common side effects with oral medications like Tecfidera and Vumerity include gastrointestinal issues such as nausea, vomiting, diarrhea, or stomach pain. Flushing, characterized by redness, itching, or a rash, is also common, particularly when starting treatment. Taking these medications with food may help reduce gastrointestinal side effects, and aspirin can sometimes lessen flushing.
Injectable interferon-based treatments, such as Plegridy and Avonex, commonly cause flu-like symptoms, including muscle and joint pain, chills, and fever. These symptoms typically last a day or two after the injection. Injection site reactions, such as pain, bruising, redness, or swelling, are also common. Patients can manage flu-like symptoms by staying hydrated and administering the medication before sleep. Warming the injectable to body temperature prior to injection and rotating injection sites can help minimize local reactions.
A serious but rare risk associated with some MS drugs, particularly Tysabri, is Progressive Multifocal Leukoencephalopathy (PML). PML is a severe brain infection caused by the JC virus, which can lead to disability or be fatal. The risk of PML is higher in patients infected with the JC virus, those who have received the medication for a long duration, or have previously used immunosuppressants. Healthcare providers monitor for PML through regular testing for JCV antibodies and by observing for any new or worsening neurological symptoms. Patients should immediately report any concerning symptoms, such as weakness on one side of the body, clumsiness, vision problems, or changes in thinking and memory.