Numerous infusion DMTs are available, and they differ by how they work and what side effects they can produce.
Ocrelizumab (Ocrevus)
Ocrelizumab (Ocrevus) is a monoclonal antibody, a lab-made protein that acts like your immune system’s antibodies. The drug targets white blood cells called CD20-positive B lymphocytes (B cells with the surface protein CD20), which contribute to nerve damage in the central nervous system. It’s the only FDA-approved medication to treat a type of MS called primary-progressive MS, and it’s also approved to treat relapsing forms of MS.
Infusion reactions, ranging from a mild rash and fever to serious issues affecting your breathing and heartbeat, are the most common side effects. Treatment with antihistamines, acetaminophen (Tylenol), and steroids before the infusion can help reduce the risk and severity of these reactions.
The drug can also increase your risk for various infections and other issues, including:
- Lower respiratory tract infections
- Upper respiratory tract infections
- Skin infections
- Herpes
- Hepatitis B (reactivated if you were previously treated for it)
- Progressive multifocal leukoencephalopathy (PML), a rare but life-threatening brain infection caused by the John Cunningham virus
- Cancer, including breast cancer
- Colitis (colon inflammation)
Ublituximab (Briumvi) and Rituximab (Rituxan)
Natalizumab (Tysabri)
Natalizumab (Tysabri) is a lab-made monoclonal antibody that blocks immune cells from passing through the blood-brain barrier into the central nervous system, reducing inflammation. Common side effects include:
- PML
- Increased risk of infections
- Infusion reactions
- Headaches
- Fatigue
- Gastrointestinal issues
- Liver damage
Natalizumab-sztn (Tyruko) is a new biosimilar of Tysabri, meaning it’s made from the same type of source (whether plant or animal cells or microorganisms such as yeast or bacteria) and carries all of the same risks and benefits.
Alemtuzumab (Lemtrada)
Alemtuzumab (Lemtrada) reduces inflammation and myelin damage by targeting the CD52 protein on the surface of certain B and T cells. If you’re treated with this drug, your healthcare provider will closely monitor your health, especially your blood counts, because it can cause severe side effects, including:
- Secondary autoimmune conditions such as Graves’ disease and immune thrombocytopenia
- Cancers such as thyroid cancer and melanoma
- Hyperthyroidism and hypothyroidism (overactive and underactive thyroid, respectively)
- Bone marrow issues
- Stroke
- Infusion reactions
- Kidney problems
- Serious infections
- Bleeding disorders such as hemophilia
- Swelling or inflammation of the colon, liver, gallbladder, and lung tissue
- Multifocal leukoencephalopathy (PML)
Mitoxantrone (Novantrone)
Mitoxantrone (Novantrone), one of a group of medications called antineoplastics, treats MS by suppressing T cells, B cells, and macrophages (another type of white blood cell). Originally used to treat cancer, mitoxantrone is rarely used for MS today due to life-threatening side effects, particularly heart failure and leukemia.
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