Moa promotes anti inflammatory and cytoprotective

 MOA: promotes anti-inflammatory and cytoprotective activities
through the Nrf2 pathway

PTIV Exam 5
 Indicated for CIS, RRMS, SPMS
 DI: live vaccines
 Limited pregnancy data
 SE: flushing (improves with continued use, can use ASA 30 min before dose),
Abdominal pain, D, N, increased risk of infection, hepatotoxicity, skin rash,
pruritis, hypersensitivity rxns (at any time)
 Warnings: anaphylaxis, angioedema, PML, lymphopenia
 Monitor: CBC with diff before & every 6 months, LFTs at baseline during
 Take with Food to reduce GI sx
Diroximal
Fumarate
 Bioequivalent to dimethyl fumarate  metabolized to monomethyl fumarate
 MOA: promotes anti-inflammatory and cytoprotective activities
through the Nrf2 pathway
 Approved for CIS, RRMS, SPMS
 DI: live vaccines
 AVOID in pregnancy
 SE: flushing, abdominal pain, D, N (GI SE less than dimethyl fumarate),
infections, hepatotoxicity
 Warnings: PML, lymphopenia
 If administering with food, limit fat to < 30 g & calories to < 700
 Monitor: CBC with diff before & every 6 months, LFTs at baseline during
Monomet
hyl
Fumarate
 Bioequivalent to dimethyl fumarate (active metabolite)
 Delayed release capsules available
 MOA: promotes anti-inflammatory and cytoprotective activities
through the Nrf2 pathway
 Approved for CIS, RRMS, SPMS
 DI: Avoid live vaccine s
 SE: flushing (may use ASA 30 min before), abdominal pain, D, N, anaphylaxis,
angioedema, infection, hepatotoxicity
 Warnings: PML, lymphopenia
 Monitor: CBC with diff before & every 6 – 12 months, LFTs at baseline during
Fingolimo
d
 MOA: Binds to sphingosine 1-phosphate receptors and blocks the ability of
lymphocytes to emerge from lymph nodes  dec # of lymphocytes available
to the CNS
 Indicated for CIS, RRMS, SPMS
 First dose, and any doses following a 14+ day therapy interruption
should be administered in a physician’s office
 Risk of fetal harm  contraceptives during & 2 months after tx
 SE: lymphopenia, infections, HA , abdominal pain, D, inc LFTs, pain in arms,
legs, back, dec respiratory function, macular edema ( Avoid in diabetes ),
HTN
 Warnings: bradycardia, AV block (CI in pts with recent CV events &
antiarrhythmics), PML , posterior reversible encephalopathy syndrome
(PRES) – sudden onset of HA, AMS, visual disturbances, seizures  911!
 Monitor: CBC w/ diff, LFTs, ECG
Siponimo
d
 MOA: more selective than fingolimod  sphingosine 1 phosphate receptor
modulator
 First dose  GIVE in physician’s office
 Indicated for CIS, RRMS, SPMS
 Contraceptives during & 10 days after therapy
 SE: lymphopenia, infections, HA, inc LFTs, macular edema, HTN, dec
respiratory functions
 Warnings: bradycardia, AV block (CI with recent CV event & pts with
CYP2C9*3/*3 genotype)

PTIV Exam 5
 Monitor: CBC w/ diff, LFTs, ECG
 NOT to use after tx with alemtuzumab
Ozanimod  MOA: sphingosine 1-phosphate receptor modulator
 Approved for CIS, RRMS, SPMS
 Contraceptives during & 3 months after therapy
 SE: lymphopenia, infections, HA, inc LFTs, macular edema , HTN, dec
respiratory functions, back pain, orthostatic hypoTN
 Warnings: bradycardia & AV block (CI with recent CV events or sleep
apnea), PML, PRES  bradycardia NOT as severe as previous agents  DO
NOT NEED OFFICE ADMIN
 Monitor: CBC w/ diff, LFTs, ECG
 Contraindicated with monoamine oxidase inhibitors (MAOIs)
Terifluno
mide
 MOA: inhibits pyrimidine synthesis  Cytostatic effect on rapidly dividing T-
and B-lymphocytes in the periphery
 Indicated for CIS, RRMS, SPMS
 DI: immunosuppressants, vaccines
 CI in pregnancy  must have negative pregnancy test before starting