August 20, 2014
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Multiple Sclerosis

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Disease-modifying medications


Disease-modifying medications help to slow down the course of MS.

(There are also other types of medication for MS, such as medications to manage MS symptoms – to learn more about this type of medication, see Other multiple sclerosis therapies.)

There are a variety of disease-modifying medications available for MS:



How it is taken: TECFIDERA® is taken by mouth (the starting dose is one capsule twice daily, with or without food, for 7 days; after this, the regular dose is 2 capsules twice daily with or without food). Swallow each capsule whole. Do not divide, crush, dissolve, suck, or chew the capsule.

What it does: TECFIDERA® is used for relapsing-remitting MS to:

  • help reduce the number of attacks (relapses) that occur
  • slow the buildup of physical problems due to MS (disability progression)

How it works: TECFIDERA® may work by changing the way the immune system works, to help keep it from further damaging the brain and spinal cord.

Side effects and precautions: Like any medication, TECFIDERA® may cause side effects. It is important to keep in mind that not everyone who takes TECFIDERA® will experience these side effects.

The most common side effects are flushing and stomach upset. People are more likely to have flushing or stomach upset during the first month of taking the medication. Most people have mild-to-moderate symptoms and they tend to go away over time. Signs of flushing may include becoming warm in the face or body, feeling warm or hot, feeling itchy, or a burning sensation. If you become flushed and get swelling of the face, lips, mouth or tongue, wheezing, difficulty breathing, or shortness of breath, stop taking TECFIDERA® and seek emergency medical assistance. Signs of stomach upset may include diarrhea, nausea, stomach pain or stomach cramps, vomiting, or indigestion.

Talk to your doctor about how to manage these side effects. Your doctor may reduce your dose. Do not reduce your dose unless your doctor tells you to. Taking TECFIDERA® with food may help manage these side effects. Your doctor may recommend taking an over-the-counter pain and fever reducer, such as aspirin, for a few days to manage signs of flushing.

Other common and potentially serious side effects may include:

  • lower number of lymphocytes (a type of blood cell). Symptoms may include serious infections, e.g., pneumonia, or being more prone to infections. Your doctor may order a blood test before you start TECFIDERA® , after 6 months, and periodically while you are on treatment, to see how many lymphocytes are in your blood. Lymphocytes are important for helping the body to fight infections. Patients with very low lymphocyte counts may get infections more easily because there are fewer cells to fight infections.
  • mild increases in the levels of certain liver enzymes in the blood. Symptoms may include loss of appetite, fatigue, yellowing of the skin or eyes, or dark urine. Your doctor may order a blood test before you start TECFIDERA® , and periodically while you are on treatment, to check the levels of those liver enzymes in your blood.
  • protein in the urine. Symptoms may include swelling of the face or legs. Your doctor may order a urine test before you start TECFIDERA® and periodically during treatment, to check your urine.

An uncommon but serious side effect of TECFIDERA® is an allergic reaction. Symptoms include rash; itching; difficulty breathing; and swelling of the face, lips, tongue or throat. Seek emergency medical assistance if this occurs.

It's important to speak to your doctor or pharmacist before using TECFIDERA® during pregnancy or breast-feeding.

Note: This is not a complete list of all possible side effects and precautions. For a complete list, see the product's full prescribing information and consumer information - ask your neurologist or pharmacist for a copy, or visit the Health Canada Drug Product Database (http://webprod5.hc-sc.gc.ca/dpd-bdpp/) and enter the brand name of the drug in the Product Name field. Talk to your neurologist or pharmacist for full information on side effects of a particular medication and how it may interact with other medications you are taking.

How it is taken: GILENYA® is taken by mouth (regular dose is one capsule once daily with or without food).

What it does: GILENYA® is used for relapsing-remitting MS to:

  • help reduce the number of attacks (relapses) that occur
  • reduce inflammation in the brain (brain lesions identified on MRI scans)
  • slow the build-up of physical problems due to MS (disability progression)

GILENYA® is generally recommended for MS patients who have had an inadequate response to, or are unable to tolerate, one or more other therapies for MS.

How it works: GILENYA® reduces the number of white blood cells (lymphocytes) in the blood by preventing them from moving freely throughout the body. In MS, when lymphocytes reach the brain and spinal cord, they are believed to cause the inflammation that contributes to myelin loss. GILENYA® may keep these cells from reaching the brain and spinal cord.

Side effects and precautions: Like any medication, GILENYA® may cause side effects. It is important to keep in mind that not everyone who takes GILENYA® will experience these side effects. Very common side effects include:

  • infection from flu virus, with symptoms such as tiredness, chills, sore throat, joint or muscles aching, fever
  • headache
  • diarrhea
  • back pain
  • cough
  • abnormal liver function tests

GILENYA® may also cause an increased risk of other infections, some of which can be serious (e.g., bronchitis, gastroenteritis, sinusitis, herpes, or fungal infections of the hair, skin, or nails). People who have not had chickenpox or the chickenpox vaccine are at risk of having a serious and life-threatening chickenpox infection during treatment with GILENYA. If you have not had chickenpox infection or chickenpox vaccine, your doctor will recommend that you have the chickenpox vaccine one month before starting treatment with GILENYA®.

Other serious side effects may include:

  • slow or irregular heartbeat – Because GILENYA® can have side effects involving the heart, you will have an electrocardiogram (ECG), which measures the electrical activity of your heart, to check on the health of your heart before you are given your first dose of GILENYA®. Your doctor will then ask you to stay in the clinic for 6 hours after your first dose so that a health care professional can monitor your heartbeat and blood pressure every hour for heart-related side effects. A second EGC will be given at the end of the 6-hour observation period. In the event of abnormal ECG findings or slowed heart rate at the end of the 6-hour observation period, you will need to be observed longer in a health care facility.
  • pneumonia (symptoms include fever, cough, or difficulty breathing)
  • symptoms of an eye problem called "macular edema" (vision changes such as shadows or a blind spot in the center of the vision; blurred vision; or problems seeing colours or details)
  • liver problems (symptoms include nausea, vomiting, appetite loss, swelling and/or pain in the abdomen, fatigue, itching, dark urine, or yellowing of the skin or eyes)
  • trouble breathing

If you are planning a pregnancy, it's important to know that you should not take GILENYA® during pregnancy or breast-feeding, and you should not get pregnant within 2 months of stopping GILENYA® (the medication can stay in your body for up to 2 months).

Note: This is not a complete list of all possible side effects and precautions. For a complete list, see the product's full prescribing information and consumer information. Talk to your neurologist or pharmacist for full information on side effects of a particular medication and how it may interact with other medications you are taking.

How it is taken: COPAXONE® is given once a day as an injection under the skin. An injection under the skin is also called a subcutaneous (SC) injection. Before you give yourself an SC injection, be sure that you've received adequate training from your health care professional on the technique of giving yourself an SC injection.

What it does: COPAXONE® is used for people with relapsing-remitting MS to reduce the frequency of relapses. It is also used for people who have suspected MS (a single attack plus abnormal MRI scan results).

How it works: This medication contains a mixture of small proteins that are similar to a protein found in myelin. It is thought to work by modifying the immune processes that are believed to be involved in MS.

Side effects and precautions: Like any medication, COPAXONE® may cause side effects. It is important to keep in mind that not everyone who takes COPAXONE® will experience these side effects. The most common side effect is an injection site reaction (redness, pain, inflammation, itching or a lump at the site of injection). These reactions are usually mild and seldom require professional treatment. Other side effects include:

  • anxiety
  • back, neck or joint pain
  • chest pain, pressure, or tightness
  • depression
  • headache
  • heart beat racing or skipping a beat
  • low or high blood pressure
  • rash or hives
  • shortness of breath
  • swelling of the arms, legs or face
  • vision changes

COPAXONE® may also cause a reaction just after injecting the medication. During the reaction, there may be symptoms such as flushing (a feeling of warmth or redness), anxiety, trouble breathing, chest tightness or chest pain, throat tightness, hives, and heart palpitations. These symptoms generally appear within minutes of an injection, last about 15 minutes, and go away by themselves without further problems.

If you are planning a pregnancy, it's important to know that you should seek a doctor's advice before taking COPAXONE® during pregnancy or breast-feeding.

Note: This is not a complete list of all possible side effects and precautions. For a complete list, see the product's full prescribing information. Talk to your neurologist or pharmacist for full information on side effects of a particular medication and how it may interact with other medications you are taking.

How it is taken: AVONEX® is given once a week as a single injection into the muscle (also called an intramuscular [IM] injection). Before you give yourself an IM injection, be sure that you've received adequate training from your health care professional on the technique of giving yourself an IM injection.

What it does: AVONEX® is used for people with relapsing forms of MS to:

  • slow the progression of disability
  • decrease the frequency of relapses
  • decrease the number and volume of active brain lesions as shown on an MRI scan

It is also used for people with secondary progressive MS (who are still having relapses) to:

  • reduce the frequency of relapses
  • decrease brain lesions as shown on an MRI scan

As well, it is used for people who have suspected MS (had a single attack plus abnormal MRI scan results) to delay the onset of "clinically definite MS" (defined as having 2 separate attacks) and decrease the number and volume of active brain lesions and overall disease burden as shown on an MRI scan.

How it works: This medication is a form of a protein called interferon beta that occurs naturally in the body. It modifies the immune system response but the exact way that it works in MS is unknown.

Side effects and precautions: Like any medication, AVONEX® can cause side effects. It is important to keep in mind that not everyone who takes AVONEX® will experience these side effects.

The most common side effect of AVONEX® is flu-like symptoms, which can include fever, chills, sweating, muscle aches, and tiredness. These symptoms last for about a day after the injection.

Other less common side effects include:

  • blood problems (causing increased risk of infections, fatigue, or increased risk of bruising or bleeding)
  • depression
  • heart problems
  • liver problems (symptoms include nausea, vomiting, appetite loss, swelling and/or pain in the abdomen, fatigue, itching, dark urine, or yellowing of the skin or eyes)
  • thyroid problems (symptoms include feeling cold or hot all the time, weight gain or loss without a change in diet or exercise, or feeling emotional)
  • seizures

If you are planning a pregnancy, it's important to know that you should not take AVONEX® during pregnancy or breast-feeding.

Note: This is not a complete list of all possible side effects and precautions. For a complete list, see the product's full prescribing information and consumer information - ask your neurologist or pharmacist for a copy, or visit the Health Canada Drug Product Database (http://webprod5.hc-sc.gc.ca/dpd-bdpp/) and enter the brand name of the drug in the Product Name field. Talk to your neurologist or pharmacist for full information on side effects of a particular medication and how it may interact with other medications you are taking.

How it is taken: REBIF® is given 3 times per week as an injection under the skin. An injection under the skin is also called a subcutaneous (SC) injection. Before you give yourself an SC injection, be sure that you've received adequate training from your health care professional on the technique of giving yourself an SC injection.

What it does: REBIF® is used for people with relapsing forms of MS to reduce the number and severity of relapses and slow the progression of disability (prolong the time physical ability is maintained). It is also used for people who have suspected MS (a single attack plus abnormal MRI scan results).

How it works: This medication is a form of a protein called interferon beta that occurs naturally in the body. It modifies the immune system response, but the exact way that it works in MS is unknown.

Side effects and precautions: Like any medication, REBIF® may cause side effects. It is important to keep in mind that not everyone who takes REBIF® will experience these side effects. The most common side effects of REBIF® include flu-like symptoms (such as headache, fever, chills, sweating, fatigue, and muscle aches) and injection site reactions (such as redness, pain, swelling, discoloration, or skin breakdown).

Other less common side effects can include:

  • blood problems (causing increased risk of infections, fatigue, or increased risk of bruising or bleeding)
  • depression
  • diarrhea
  • difficulty sleeping
  • dizziness
  • hair loss
  • liver problems (symptoms include nausea, vomiting, appetite loss, swelling and/or pain in the abdomen, fatigue, itching, dark urine, or yellowing of the skin or eyes)
  • loss of appetite
  • palpitations
  • rash
  • relaxing and widening of blood vessels
  • thyroid problems (symptoms include feeling cold or hot all the time, weight gain or loss without a change in diet or exercise, or feeling emotional)
  • vomiting

When beginning treatment with REBIF®, some people may experience symptoms similar to an MS relapse (e.g., muscle tenseness or weakness, which may affect your movements).

If you are planning a pregnancy, it's important to know that you should not take REBIF® during pregnancy or breast-feeding.

Note: This is not a complete list of all possible side effects and precautions. For a complete list, see the product's full prescribing information and consumer information. Talk to your neurologist or pharmacist for full information on side effects of a particular medication and how it may interact with other medications you are taking.

How it is taken: BETASERON® is given as a single injection every other day under the skin (also called a subcutaneous [SC] injection). Before you give yourself an SC injection, be sure that you've received adequate training from your health care professional on the technique of giving yourself an SC injection.

What it does: BETASERON® is used for people with relapsing-remitting MS. It can reduce the frequency of relapses. It can also be used to delay the onset of clinically definite MS for people who have suspected MS (a single attack combined with at least 2 MS lesions on their MRI scans).

It is also used for people with secondary progressive MS to:

  • slow the progression of disability
  • reduce the frequency of relapses

How it works: This medication is a form of a protein called interferon beta that occurs naturally in the body. It modifies the immune system response, but the exact way that it works in MS is unknown.

Side effects and precautions: Like any medication, BETASERON® may cause side effects. It is important to keep in mind that not everyone who takes BETASERON® will experience these side effects. The most common side effects of BETASERON® include flu-like symptoms (such as fever, chills, sweating, muscle aches, and tiredness), injection site reactions (such as redness, pain, swelling, discoloration, break in skin, or drainage of fluid), rash, and lack of coordination (in moving fingers, arms, legs, or other muscular movement).

Other less common side effects include:

  • blood problems (causing increased risk of infections, fatigue, or increased risk of bruising or bleeding)
  • liver problems (symptoms include nausea, vomiting, appetite loss, swelling and/or pain in the abdomen, fatigue, itching, dark urine, or yellowing of the skin or eyes)
  • depression
  • fluid retention
  • seizures

If you are planning a pregnancy, it's important to know that you should not take BETASERON® during pregnancy or breast-feeding.

Note: This is not a complete list of all possible side effects and precautions. For a complete list, see the product's full prescribing information and consumer information. Talk to your neurologist or pharmacist for full information on side effects of a particular medication and how it may interact with other medications you are taking.

How it is taken: EXTAVIA® is given as a single injection every other day under the skin. An injection under the skin is also called a subcutaneous (SC) injection. Before you give yourself an SC injection, be sure that you've received adequate training from your health care professional on the technique of giving yourself an SC injection.

What it does: EXTAVIA® is used for people with relapsing-remitting MS. It can reduce the frequency of relapses. It can also be used to delay the onset of clinically definite MS for people who have suspected MS (a single attack combined with at least 2 MS lesions on their MRI scans).

It is also used for people with secondary progressive MS to:

  • slow the progression of disability
  • reduce the frequency of relapses

How it works: This medication is a form of a protein called interferon beta that occurs naturally in the body. It modifies the immune system response but the exact way that it works in MS is unknown.

Side effects and precautions: Like any medication, EXTAVIA® may cause side effects. It is important to keep in mind that not everyone who takes EXTAVIA® will experience these side effects. The most common side effects of EXTAVIA® include flu-like symptoms (such as fever, chills, sweating, muscle aches, and tiredness), injection site reactions (such as redness, pain, swelling, discoloration, break in skin, or drainage of fluid), and rash.

Other less common side effects include:

  • blood problems (causing increased risk of infections, fatigue, or increased risk of bruising or bleeding)
  • liver problems (symptoms include nausea, vomiting, appetite loss, swelling and/or pain in the abdomen, fatigue, itching, dark urine, or yellowing of the skin or eyes)
  • depression
  • fluid retention
  • seizures

If you are planning a pregnancy, it's important to know that you should not take EXTAVIA® during pregnancy or breast-feeding.

Note: This is not a complete list of all possible side effects and precautions. For a complete list, see the product's full prescribing information and consumer information. Talk to your neurologist or pharmacist for full information on side effects of a particular medication and how it may interact with other medications you are taking.

How it is taken: TYSABRI® is given as an intravenous (IV) infusion (a slow injection into a vein) once every 4 weeks. The infusion must be given by a health care professional in an infusion clinic. The infusion usually lasts for one hour. During the infusion and for one hour after the infusion is finished, you will be monitored by a health care professional to check for any reactions (known as infusion reactions) to the medication.

What it does: TYSABRI® is used for people with relapsing-remitting MS to decrease the number of MS attacks and slow down the progression of disabling effects of MS.

How it works: This medication is a man-made protein that works by preventing active immune system cells from reaching the brain.

Side effects and precautions: Like any medication, TYSABRI® may cause side effects. It is important to keep in mind that not everyone who takes TYSABRI® will experience these side effects. Common side effects of TYSABRI® include:

  • dizziness
  • fever
  • headache
  • joint pain
  • itchy rash
  • nausea or vomiting
  • shivering
  • sore throat and runny or stuffy nose
  • tiredness
  • urinary tract (bladder) infection

Other less common side effects can include:

  • PML (progressive multifocal leukoencephalopathy), a rare but serious brain infection that can lead to further disability and even death (symptoms of PML are similar to MS relapse, such as weakness or clumsiness, vision changes, or trouble with thinking). If you notice any new MS symptoms or if your MS seems to be getting worse, this may be a sign of PML. Speak to your neurologist as soon as possible if this happens. For more information on PML, see the boxed warning below.
  • infusion-related reactions (headache, dizziness, fatigue, hives, or chills occurring within 2 hours of the start of the infusion)

There have been uncommon cases of a brain infection by JC virus resulting in progressive multifocal leukoencephalopathy (PML) occurring in patients who have been given TYSABRI®. PML is associated with an uncontrolled increase of the JC virus in the brain, although reason for this increase in some patients treated with TYSABRI® is unknown. PML usually happens in people with weakened immune systems, but it is difficult to predict who will get PML. PML may lead to severe disability or death; there is no known cure.

In order to receive TYSABRI® you must talk to your doctor and understand the benefits and risks of TYSABRI® and consent to treatment prior to receiving your first treatment. After 24 months of treatment you should again talk to your doctor, understand the benefits and risks of TYSABRI® treatment and consent to continuation of treatment.

You should agree to enrol into the Canadian Tysabri Care Program, which is a patient registry, by contacting 1-888-827-2827.

If you are planning a pregnancy, it's important to know that you should not take TYSABRI® during pregnancy or breast-feeding.

Note: This is not a complete list of all possible side effects and precautions. For a complete list, see the product's full prescribing information and consumer information - ask your neurologist or pharmacist for a copy, or visit the Health Canada Drug Product Database (http://webprod5.hc-sc.gc.ca/dpd-bdpp/) and enter the brand name of the drug in the Product Name field. Talk to your neurologist or pharmacist for full information on side effects of a particular medication and how it may interact with other medications you are taking.

What next?

It's important to take an active role in your MS treatment:

  • Track your symptoms (use the Multiple Sclerosis Symptom Log) and let your neurologist know if there are any changes.
  • Find out if you're getting the most from your treatment with our Treatment Check-Up Tool.
  • Use our Doctor Discussion Guide to talk to your neurologist about your treatment options. If you are on medication, take it as directed. If you are having trouble taking your medication, ask your pharmacist or neurologist for help.

MS Treatment Check-Up

Are you currently being treated for MS?

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YES NO

It might be time to talk to your neurologist. Complete this tool to find out about the next steps in managing your condition.

Have you spoken to your neurologist recently about your condition?

Complete the MS Doctor Discussion Guide to find out some common issues you may want to talk to your doctor about.

Don't forget to bring the summary with you.

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YES NO

You've finished your treatment check-up. Click below to get your results!

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Based on your answers, it may be time to discuss optimal treatment with your neurologist.
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What next?

1. Bring these results to your appointment:

2. Use the Doctor Discussion Guide to help you organize your questions and information for the doctor. Bring your results to your appointment.

3. Learn more about how to get the most from your treatment:


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