Individualizing treatment according to a patient’s risk profile starting with high-efficacy treatments helps prevent irreversible brain and spinal cord damage, thus leading to better outcomes.
- First Line: Natalizumab (Tysabri) in JCV negative patients, rituximab (Rituxan), ocrelizumab (Ocrevus) and ofatumumab (Kesimpta)
- Second Line: Fingolimod (Gilenya), siponimod (Mayzent), ozanimod (Zeposia), dimethyl fumarate (Tecfidera), monomethyl fumarate (Vumerity)
- Third Line: Teriflunomide (Aubagio), glatiramer acetate (Copaxone, Glatopa, generic GA), beta interferons (Avonex, Rebif, Betaseron, and others).
- Fourth Line (only to be used in patients who have failed multiple other therapies): Natalizumab in JCV positive patients, alemtuzumab (Lemtrada), cladribine (Mavenclad), stem cell transplant (HSCT)
Source: Rocky Mountain MS Center Medical Director Dr. Timothy Vollmer
