DMT presentation by Lenus Buzgoi at the Chelsea and Westminster MS Group.

1. DISEASE MODIFYING
THERAPY
(DMT)
U.K. LICENCED DRUGS

2. SEVEN DMT’S LICENSED IN THE U.K.
•
•
•
•
•
•
•
Avonex (beta interferon – 1a)
Rebif (beta interferon – 1a)
Betaferon (beta interferon – 1b)
Extavia (beta interferon – 1b)
Copaxone (glatiramer acetate)
Tysabri (natalizumab)
Gilenya (fingolimod)

3. INTERFERON BETA
• Protein naturally produced by the human body
• Help fight infections
• Play important role in the functioning of the immune
system
• They work by blocking the action of gamma interferons
who are thought to induce MS symptoms
• They reduce the autoimmune reaction that results in
inflammation and destruction of myelin

4. GLATIRAMER ACETATE
• Thought that prevent the production of myelin
reactive immune cells
• Also, induces the generation of anti-inflammatory
immune cells
• Reducing the damage to myelin and nerve fibres

5. NATALIZUMAB
• Prevent the passage of immune cells (white blood
cells) across the blood-brain barrier
• It is binding to a specific molecule on the immune
cell surface preventing the attraction between the
surface of these cells and the surface of the bloodbrain barrier
• The drug prevents the migration of the immune cells
into the central nervous system, where they can
cause inflammation and damage

6. FINGOLIMOD
• A specialised type of immune cell, called a T-cell is
thought to be responsible for much of the damage
caused in relapsing remitting MS
• Acts by grabbing these T-cells from the blood
stream and trapping them inside organs in the body
called lymph nodes
• This action prevents these T-cells from getting into
the brain and causing damage

7. WHO ARE THESE DRUGS
RECOMMENDED FOR?
• People with relapsing remitting MS who have
experienced at least two ‘clinically significant’ relapses
in the last two years
• People with secondary progressive MS who are still
experiencing relapses, and where these relapses are the
predominant cause of their increasing disability
• People with ‘clinically isolated syndrome’, when MRI
scans show a high likelihood that they will go on to
develop MS
• Children and young people with relapsing remitting MS

8. COMPARING THE DRUGS
Interferon
beta
1a
Interferon
beta
1a
Interferon
beta
1b
Interferon
beta
1b
Biogen Idec
Merck Serono
Rebif
Betaferon
Bayer
Schering
S.C
Alternate
days
S.C
Bayer
Schering/Nov
artis
Alternate
days
S.C
1 x week
3 x week
I.M
Pre-filled
syringe and
bio-set
Yes
No
No
Yes
Pre-mix 2-8°C
single vial at
room temp
up to 1 wk.
Bio-set room
temp up to 2
yrs
Yes
In fridge
between 28°C
At room temp
At room temp
In fridge
between 28°C or at
room temp
for up to 1
month
Yes
Yes
Yes
No
Flu-like
symptoms
Flu-like
symptoms
Flu-like
symptoms
Flu-like
symptoms
Changes in
menstruation/
periods,
blood
abnormalities,
neurological
symptoms,
mood
changes
Changes in
menstruation/
periods,
blood
abnormalities,
neurological
symptoms,
mood
changes
Changes in
menstruation/
periods,
blood
abnormalities,
neurological
symptoms,
mood
changes
Changes in
menstruation/
periods,
blood
abnormalities,
neurological
symptoms,
mood
changes
Injection site
reactions
and
lipoatrophy
Chest
tightness,
breathlessne
ss, anxiety,
flushing,
palpitations.
Typically last
a few
minutes.
Avonex
Manufacture
r
How often
Is it given
How is it
injected
Does it
come premixed
Storage
Regular
blood tests
Common
side effects
Less
common
side effects
Extavia
Glatiramer
acetate
Copaxone
Teva
Every day
S.C

9. SIDE EFFECTS
• Flu- like symptoms
• Site injection problems
• Mood changes
• Neurological symptoms
• Changes in menstrual periods
• Liver function and blood count

10. NEUTRALISING ANTIBODIES
• Sometimes the body’s immune system begins to react
against beta interferon by producing antibodies which
might prevent the drug from being effective
• This can be checked by a blood test
• In some cases level of antibodies go down over time
• Sustained, high level of neutralising antibodies might
suggest that the drug is no longer effective, and can be
a factor in choosing to stop treatment

11. STOPPING THE DRUGS
• Due to any signs of a serious side effect or adverse
reaction
• If the side effects are intolerable
• If you are planning to get pregnant
• If you develop an increased number and severity of
relapses
• If you do not see a reduction in the number of relapses
compared to the one to two years before you started
taking it
• If you develop ‘neutralising antibodies’
• If you develop secondary progressive MS and can no
longer walk
• If a more suitable treatment becomes available

12. SWITCHING DRUGS
• Yes, you can switch to another drug that you are
eligible for
• Note that if you switch from a beta interferon
because of neutralising antibodies, it only makes
sense to switch to glatiramer acetate as the bodies
will neutralize other forms of interferons as well

13. INJECTION
• Subcutaneous (under the skin) or intramuscular (into
the muscle)
• ‘Auto-inject’ – a system where you cannot see the
needle and the action of injecting comes down to
the click of the ‘pen’ holding the syringe
• Rebif – uses ‘RebiSmart’- a device using pre-filled
syringe cartridges which only need loading once a
week
• A nurse will teach you the good injection technique

14. STORAGE
• Different drugs have different storage requirements
• Most need to be kept in the fridge
• Also, you will need a safe space to store syringes
and discarded needles
• The drug company will supply a box for these
discarded ‘sharps’

15. TRAVELLING
• A travel bag will be given when you start the
treatment, with ice packs
• All drugs can be stored at the room temperature for
a limited period of time
• In case of delays in travelling you should have few
more doses with you
• Air travel- keep your travel bag in the cabin;
contact them in advance to inform about
medication; your MS nurse can provide you with a
letter to explain the need to travel with your drug;
also, the drug company can provide you with
paperwork to help with travel

16. FURTHER INFORMATION
• MS Society
• MS Decisions
• National Institute for Health and Clinical Excellence
(NICE)
• MS UK
• MS Trust
•
• Association of British Neurologists (ABN)