Inflammation and Oxidative Stress in Multiple Sclerosis: Consequences for Therapy Development

Table 3

List of FDA-approved disease-modifying therapies to treat multiple sclerosis, adapted from [128, 129, 188, 189].

Drug	Route of administration	Drug class	Mechanism of action	Treatment strategy	Main possible side effects when compared to placebo	Approved indication
Interferon beta-1a	Injection	Protein biologic	Immunomodulatory	First line	Injection site reaction, influenza-like symptoms, lymphopenia, depression	RRMS
Interferon beta-1b	Injection	Protein biologic	Immunomodulatory	First line	Injection site reaction, influenza-like symptoms, lymphopenia, depression	RRMS
Glatiramer acetate	Injection	Peptide polymer	Immunomodulatory	First line	Injection site reactions, vasodilatation, rash, dyspnea, chest pain	RRMS
Teriflunomide	Oral	Small molecule	Immune suppressive	First line	Hepatotoxicity, alopecia, diarrhea, influenza, nausea, and paresthesia	RRMS
Fingolimod	Oral	Small molecule	Immunomodulatory	First line	Headache, liver transaminase elevation, diarrhea, cough, influenza, sinusitis, pain	RRMS
Dimethyl fumarate	Oral	Small molecule	Immunomodulatory	First line	Flushing, abdominal pain, diarrhea, nausea	RRMS
Cladribine	Oral	Small molecule	Immune suppressive	First or second line	Upper respiratory tract infection, headache, lymphopenia	RRMS, SPMS
Siponimod	Oral	Small molecule	Immunomodulatory	First line	Headache, hypertension, transaminase increases	RRMS, SPMS
Alemtuzumab	Infusion	Humanized mAb	Immune suppressive	Second or third line	Infusion reactions, infections, rash, headache, pyrexia	RRMS
Mitoxantrone	Infusion	Small molecule	Immune suppressive	Second or third line	Nausea, alopecia, urinary tract infection, cardiotoxicity, menstrual disorders	RRMS, SPMS
Ocrelizumab	Infusion	Humanized mAb	Immune suppressive	First or second line	Infusion reactions, skin and respiratory tract infections	RRMM, PPMS
Natalizumab	Infusion	Humanized mAb	Inhibits immune cell trafficking into CNS	Second line	Delayed infusion reactions, progressive multifocal leukoencephalopathy (PML), hypersensitivity, immunosuppression/infections, headache, fatigue	RRMS