Ocrelizumab (Ocrevus): Medication for the treatment of multiple sclerosis (MS). This monoclonal antibody binds to the CD20 receptor on B-cells, which form a minor subset of immune cells. The U.S. Food and Drug Administration (FDA) approved the medication in March 2017 and it was the first FDA approved medication that treats primary progressive MS. The medication is considered to be high efficacy with acceptable safety. ANA was honored as a site of the phase 3 trial: https://clinicaltrials.gov/ct2/show/NCT01412333. The most common reactions during infusion are itch, hive-like rash and flushing, throat and mouth irritation. More significant reactions like fever, nausea, rapid heart beating, and dizziness may also occur. Most infusions are without any reaction.
Medication for the treatment of multiple sclerosis (and Crohn’s disease). This monoclonal antibody binds to a cell adhesion molecule called α4-integrin, preventing cells from migrating into the CNS. As such, immune cells cannot do damage to the myelin within the brain. Natalizumab is effective in treating MS. It has been linked with a rare neurological condition called Progressive Multifocal Leukoencephalopathy (PML), and is now given under a special prescription program called TOUCH. In many patients, benefits outweigh the risks. PML is monitored with blood testing and brain MRIs. Adverse effects during infusion include fatigue and allergic reactions, but most infusions occur without any reaction.
Medication used to treat autoimmune diseases including Crohn’s disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, and Behçet’s disease. Infliximab binds and neutralizes a cell signaling protein called Tissue Necrosis Factor, or TNF-a. Common side effects include infections, acute infusion reactions, and abdominal pain.
Medication to prevent migraine. This monoclonal antibody binds to and blocks calcitonin gene-related peptides (CGRP). It is given via infusion every three months. Trials show that treated subjects have less migraine days relative to placebo. Benefits are greater than risks for many patients, but risks include nasopharyngitis, upper respiratory infection, nausea, and urinary tract infection. ANA was honored as a site of the phase 3 trial: https://www.clinicaltrials.gov/ct2/show/NCT02275117
Medication used to treat a condition called neuromyelitis optica or Devic’s disease in which there is inflammation of the eye nerves and spine. It is also approved to treat myasthenia gravis, a disease where antibodies bind and block the ability of nerves to tell muscles to move. It has also been FDA approved for non-neurologic diseases. Side effects include a risk for meningococcal infections and it is only prescribed to those who been vaccinated for this. It is a monoclonal antibody that binds and prevents proteins called complement from working. Complement proteins form pores on cells and was a primitive immune protector that is pathologic in autoimmune diseases.
Drug for the treatment of various autoimmune diseases. Like ocrelizumab above, this monoclonal antibody binds to the CD20 receptor on B-cells, which form a minor subset of immune cells. It is on the World Health Organization’s list of Essential Medicines. The most common reactions during infusion are hives with itching and flushing, throat itching and irritation. More significant reactions are rare, but may also occur. Most infusions are without any reaction.