Comparisons of the effects of various medications on multiple sclerosis patients.
| Effects | Immune modulating drugs | |||
|---|---|---|---|---|
| Alemtuzumab | Dimethyl fumarate (DMF) | Natalizumab | Fingolimod | |
| Target | Decreases the number of T-cells, B-cells and monocytes/macrophages expressing CD52 | Promotes anti-inflammatory responses within the CNS by activating Th2 responses | Inhibits lymphocyte migration through BBB into the CNS by targeting α4β1-integrin | Inhibits activated lymphocytes from leaving lymph nodes by targeting S1P-receptors |
| B-cells | Decreases | Decreases | Decreases | Decreases |
| T-cells | Decreases | Decreases | Decreases | Decreases |
| Pro-inflammatory cytokines | Decreases | Decreases | Decreases | Decreases |
| Anti-inflammatory cytokines | NCD | Increases | Increases | NCD |
| Side effects (common) | Headache, pyrexia, nausea, pruritus insomnia, fatigue, chest discomfort and dyspnea | Cough or hoarseness, feeling of warmth, fever or chills, lower back or side pain, painful or difficult urination, redness of the face, neck, arms, and occasionally, upper chest | Cough, difficulty with swallowing, dizziness, fast heartbeat, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue, shortness of breath, skin rash, hives, or itching, tightness in the chest, unusual tiredness or weakness | Diarrhea, coughing, headaches, hair loss, depression, muscle weakness, dry, itchy skin |
| Side effects (rare) | Respiratory and urinary tract infections, herpetic infections (mucocutaneous herpes simplex and herpes zoster), autoimmune AE | Lymphopenia, leucopenia, WBC decreased, Ketones in urine, vitamin D decreased, cardiovascular, gastrointestinal, dermatologic, hepatic, hypersensitivity | PML, pharyngitis, urinary tract infection, urticaria, cephalgia, dizziness, nausea, vomiting, arthralgia, fever, and rigidity. | Bradyarrhythmia and atrioventricular blocks, macular edema, elevated liver function, increased risk of respiratory tract infections, urinary tract infections, regional herpes virus infections and hypertension |
| Cognition, depression and fatigue | Improves | NCD | NCD | NCD |
| Quality of life | Improves | Improves | Improves | Improves |
BBB - blood-brain barrier, ND - no conclusive data, PML - progressive multifocal leukoencephalopathy, SIP - sphingosin-1-phosphate, WBC - white blood cells, AE - adverse events