Research indicates that MS is an autoimmune disease. As immunosuppressants have been proven to be beneficial in other autoimmune diseases such as rheumatoid arthritis and psoriasis, drugs that have an immunosuppressant function have shown to be potentially beneficial in controlling disease progression in patients with MS.
Immunosuppressive drugs work by suppressing the body’s immune reaction, and they prevent the body’s ‘good’ white cells (leukocytes) from attacking each other.
Normally, leukocytes help regulate the immune system. Immunosuppressive drugs offer another way of treating MS; currently available immunosuppressants are normally used if the disease is progressing in spite of immunomodulatory treatment.
There are a variety of immunosuppressive drugs that have been used in cancer treatment and that have proved effective in treating advanced forms of MS. Specific immunosuppressive drugs used in MS therapy include azathioprine, mitoxantrone and occasionally cyclophosphamide or methotrexate. However, only Tysabri® (Natalizumab) (in the USA) and Novantrone® (Mitoxantrone) (in the USA, France and Switzerland) are currently licensed specifically for use in the treatment of MS.
Following three cases of progressive multifocal leukoencephalopathy, Tysabri® was approved for restricted use in patients with RRMS in the European Union in 2006, and was marketed under a restricted distribution programme in the USA.
The use of Tysabri® remains restricted to monotherapy for patients with RRMS who exhibit high disease activity despite treatment with IFN beta, or whose disease is rapidly evolving [12].
Brand name | Novantrone® | Tysabri® |
Manufacturer | Merck Serono | Biogen/Idec |
Description | Mitoxantrone | Natalizumab
Recombinant humanized monoclonal antibody |
Indications | Secondary progressive, progressive relapsing and worsening relapsing remitting MS (USA, France, Switzerland only) | Relapsing forms of MS (restricted to monotherapy for patients with RRMS who exhibit high disease activity) |
Administration | Short (15 minute) intravenous infusion | Intravenous infusion |
Dosing | 12 mg/m2 every three months lifetime maximum of 140 mg/m2 | 300 mg every four weeks |
Packaging | Injection concentrate supplied Dilution required | Injection concentrate supplied Dilution required |
Storage | Store concentrate at room temperature (15–25°C) | Store concentrate in a fridge Use diluted solution immediately, or store in fridge and use within 8 hours. |
Other immonusuppressants do exist, but none of these drugs are licensed specifically for use in the treatment of patients with MS. View a drug overview of immunosuppressive drugs.
