In a review posted on dovepress.com, monoclonal antibodies have established themselves as an important tool in the management of multiple sclerosis in both the relapsing-remitting form and the progressive form. There are a number of different therapies in this category that are used for this illness. They have distinct mechanisms of action and risk/benefit profiles. In this article we will provide an overview of these medicines.

About Multiple Sclerosis (MS)

Multiple sclerosis is a neurological disease which is characterized by damage to the myelin sheath, a fatty, insulating, protective covering that surrounds nerve cells and allows them to communicate effectively. Although a precise cause has not been determined, multiple sclerosis is considered an autoimmune disease, in which a certain trigger, such as an infection, may cause the immune system to mistakenly attack healthy tissue. Smoking and certain genetic variants are also considered risk factors for the disease. Symptoms include blurred vision, double vision, blindness in one eye, numbness, abnormal sensations, pain, muscle weakness, muscle spasms, difficulty speaking and swallowing, mood instability, depression, loss of coordination, and fatigue. There are a number of treatments available for the disease, but no cure. Life expectancy for patients is slightly reduced. To learn more about multiple sclerosis, click here.

Monoclonal Antibodies for MS

1. Natalizumab (marketed as Tysabri) – This drug was first approved for use in the relapsing form of multiple sclerosis in 2004. It is given in a 300mg dose one a month intravenously. While it is overall well-tolerated, it does carry a black box warning due to a small risk of potentially lethal progressive multifocal leukoencephalopathy. Despite this, it is generally considered highly effective.
2. Alemtuzumab (marketed as Lemtrada) – First approved for the relapsing form in 2014, the drug is delivered for five days in a row at 12mg/day intraveously; a year later, it is delivered at the same dose level for three days. Additional three day courses may be given as disease activity indicates. It can cause concerning side effects such as secondary autoimmunity and infections. It has high potency and durability of action.
3. Rituximab (marketed as Rituxan) – It has never been officially approved for this disease but sees off-label use. For the most part, it is used for the relapsing form. Dosing approaches include 1000mg IV two times with two weeks in between then 1000mg every two months; or 500 mg IV every six months.
4. Ocrelizumab (marketed as Ocrevus) – This is the only FDA approved therapy for both the relapsing and progressive forms. It has demonstrated decisive impacts on disability progression, loss of bran volume, and walking speed degradation. Dose is 300 mg IV with two weeks in between and then 600 mg every six months.
5. Ofatumumab (marketed as Kesimpta) – This drug was recently approved for the relapsing form. Dosing regimen is 20mg under the skin/week for the first three doses then 20 mg/month.

The last three are all anti-CD20 therapies with comparable safety profiles; risks include infections (with monitoring required to detect potentially serious ones) and potentially cancer, though this risk is generally low.

Overall, monoclonal antibodies are effective approaches for multiple sclerosis and comparative trials could reveal more about their impacts relative to each other.