Table 4 Licensed disease-modifying drugs in the European Union and/or USA
DrugNameAdministrationAdverse effects
Interferon-beta 1bBetaferon or Betaseron250 μg subcutaneously on alternate daysLocal injection-site reactions and flu-like symptoms with pyrexia, which may be reduced by paracetamol and usually subside over months; abnormal liver function; bone marrow suppression; 5–30% of patients develop persistent neutralising antibodies (higher with more frequent dosing) which may reduce efficacy
Interferon-beta 1aRebif44 μg subcutaneous three times weekly
Interferon-beta 1aAvonex30 μg intramuscular once weekly
Glatiramer acetateCopaxone30 μg subcutaneously dailyInjection site reactions; rarely a syndrome of severe pain at injection site +/− chest pain, which can occur months after starting drug
NatalizumabTysabri300 mg by intravenous infusion every 4 weeksProgressive multifocal leucoencephalopathy (?1/5000)—current licence refers to 1:1000
MitoxantroneNovantroneComplex and various infusion regimesAcute leukaemia (3/1000); cardiotoxicity (1:200)