Kesimpta, Tysabri, and More: 8 Injections and Infusions for Multiple Sclerosis
Key takeaways:
There are many injections and infusions available to treat multiple sclerosis (MS). Some examples include Avonex (interferon beta-1a), Briumvi (ublituximab-xiiy), and Tysabri (natalizumab).
You may have the option to give certain injectable MS medications to yourself at home. But others must be given at a healthcare provider’s office or at an infusion center.
Your care team will discuss your multiple sclerosis treatment options with you. A few factors to consider include how often and where the medication is administered, insurance coverage, and potential side effects.
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Table of contents
Treatment options for multiple sclerosis (MS) have changed dramatically over the past 30 years. In 1993, the FDA approved the first injectable interferon beta treatment for certain types of MS. Since then, multiple injections and intravenous (IV) infusions have become available.
When considering multiple sclerosis treatment options, there are several factors your healthcare provider may consider. For example, many injections can be given at home, while infusions usually need to be administered in a medical setting. Each treatment also has potential benefits and risks to consider for your specific situation.
So what are the long-term injectable treatment options for MS, and how do you choose the best one for you? Below, we’ll go over eight injectable treatments that are available.
1. Interferon beta medications
Interferon beta medications are a type of disease-modifying therapy (DMT) that treat relapsing types of MS. They work by suppressing the immune system. While these medications don’t offer a cure, they can slow down worsening of MS and reduce flare-ups. However, they may not work for everyone.
Common interferon beta medication side effects include flu-like symptoms and injection site reactions. To lower your risk of side effects, your healthcare provider will likely start you at a low dose and slowly raise it over time.
Interferon beta medications are injected into the muscle (intramuscularly, or IM) or under the skin (subcutaneously, or SQ). Where and how often you inject them can depend on the specific treatment, as detailed below.
Medication | Where to inject | Frequency |
|---|---|---|
Betaseron, Extavia (interferon beta-1b) | SQ | Every other day |
Avonex (interferon beta-1a) | IM | Once weekly |
Rebif (interferon beta-1a) | SQ | 3 times weekly |
Plegridy (peginterferon beta-1a) | SQ or IM | Every 2 weeks |
Avonex, Rebif, and Plegridy are available as injection pens and prefilled syringes. Betaseron and Extavia both come in a vial that needs to be mixed before injecting with a syringe. The Betaseron syringe can be placed inside an autoinjector to make the injection easier.
2. Glatiramer
Glatiramer is unique because it doesn’t weaken the immune system like other MS treatments. Instead, it’s thought to act as a decoy to prevent antibodies from attacking protective proteins on nerve cells.
The most common glatiramer side effects include injection site reactions, fever, and chills. Some people also experience temporary shortness of breath and a fast heartbeat after their dose.
There are three glatiramer products available for relapsing forms of MS: Copaxone, Glatopa, and generic glatiramer. They’re injected under the skin either once daily or 3 times a week, depending on your dose. You can inject yourself at home using the prefilled syringe. Your healthcare provider can also write you a separate prescription for a compatible autoinjector.
Brand-name Copaxone was first approved in 1996. In 2015, the FDA approved Glatopa, the first Copaxone generic. Two years later, another generic version was approved under the name glatiramer. You should expect similar benefits and risks with all three products. But you may be able to save money by choosing a generic.
3. Kesimpta
Kesimpta (ofatumumab) is an injectable monoclonal antibody. It’s thought to work by targeting B-cells (a type of immune cell) in the lymph nodes that attack protective nerve cell coverings in people with MS. Kesimpta is considered a targeted B-cell therapy.
There are other B-cell therapies available for MS. But Kesimpta was approved as the first self-administered option. This means you can administer it in the comfort of your own home instead of going to a medical office or clinic.
You’ll inject Kesimpta, which comes as a prefilled syringe and injection pen, under the skin once a week for 3 weeks. Starting at week 4, you’ll inject your dose once a month. Common Kesimpta side effects include upper respiratory tract infections (URTIs), injection-related reactions, and headache.
Since Kesimpta can affect your immune system, there’s a higher risk of serious infections. Because of this, your healthcare provider will run some tests before, during, and after you stop treatment. If you’re sick, they may have you delay your injections until you’re feeling better.
Good to know: A rare but serious brain infection called progressive multifocal leukoencephalopathy (PML) is possible with Kesimpta. While PML hasn’t been reported in people receiving Kesimpta for MS, it has occurred with higher doses used to treat cancer.
4. Briumvi
Briumvi (ublituximab-xiiy) is another B-cell therapy for relapsing forms of MS. It’s a monoclonal antibody that works in the same way as Kesimpta, but it’s given as an hour-long IV infusion. This means you need to have it administered by a healthcare professional. After the first two infusions, Briumvi is given every 24 weeks.
Similar to Kesimpta, common Briumvi side effects include infusion reactions and URTIs. During and for an hour after your first two infusions, you’ll be monitored for infusion reactions. If a serious reaction occurs, medical staff will be able to provide treatment.
Briumvi can also increase the risk of serious infections. So, it’s important to let your care team know if you’re sick before arriving for your infusion. They’ll also run some tests before, during, and after treatment. And while PML hasn’t been reported with Briumvi, it’s still possible.
5. Lemtrada
Lemtrada (alemtuzumab) is a monoclonal antibody infusion for relapsing forms of MS. Lemtrada targets several types of immune cells that can contribute to inflammation, including T-cells, B-cells, and natural killer cells.
Lemtrada is given as a 4-hour infusion in a medical setting as two or more treatment courses:
First course: Once daily for 5 days straight
Second course: Once daily for 3 days straight, 12 months after the first course
Additional 3-day courses: Can be given as long as it has been 12 months since the last dose of any previous treatment course
Lemtrada has a boxed warning (the FDA’s strictest warning) for serious side effects such as an increased risk of cancer, strokes, and autoimmune conditions. Because of this, it’s only available through a special safety program. Due to these risks, Lemtrada is typically only used if at least two other MS medications haven’t worked for you.
6. Mitoxantrone
Mitoxantrone (formerly sold as the brand name Novantrone) is an anticancer medication that’s also used to treat relapsing forms of MS. It’s thought to work by targeting different immune system cells, proteins, and chemicals that promote inflammation.
Mitoxantrone is given as a 5- to 15-minute IV infusion by a healthcare professional every 3 months. The most common side effects include nausea, hair thinning, and menstrual cycle changes. URTIs and urinary tract infections (UTIs) are also possible.
Like Lemtrada, mitoxantrone has a boxed warning. That’s because it has an increased risk of heart failure (during or even years after stopping treatment) and certain types of cancer. Experts say that mitoxantrone shouldn’t be prescribed unless the potential benefits greatly outweigh the risks since safer options are now available.
7. Ocrevus
Ocrevus (ocrelizumab) is a B-cell therapy for relapsing forms of MS. Unlike Kesimpta and Briumvi, it’s also approved for primary progressive MS. After the first two infusions, Ocrevus is given every 6 months over the course of 2 to 4 hours. You can receive infusions at home, at your provider’s office, or at an infusion center.
Like other B-cell therapies, common Ocrevus side effects include URTIs and infusion reactions. Due to the risk of infusion reactions, you'll be watched for at least 1 hour after each infusion. Keep in mind that reactions can happen for up to 24 hours after your infusion.
Ocrevus may increase the risk of cancer, including breast cancer. While rare, there have been cases of PML and immune-related colitis (colon inflammation) with Ocrevus. Let your care team know right away if you develop new or persistent diarrhea, one-sided body weakness, or vision changes during treatment.
8. Tysabri
Tysabri (natalizumab) is an IV infusion that’s given once per month by a healthcare provider. Each infusion takes about an hour. It works by keeping B-cells and T-cells in your bloodstream, and out of your central nervous system (CNS) where they can damage nerve cells. Unlike other MS treatments, Tysabri doesn’t kill B-cells or T-cells.
Tysabri has been associated with PML. For this reason, it’s only available through a restricted program called the Tysabri TOUCH Prescribing Program.
In August 2023, the FDA approved Tyruko (natalizumab-sztn) — the first biosimilar to Tysabri. Biosimilars can typically help you save money on your prescription. Tyruko has the same dosage form and regimen as Tysabri, and will also only be available through a special safety program.
How to decide between treatment options
Having many treatment options to choose from can feel overwhelming. Keep in mind that there are also oral medications for MS in addition to the injectable options covered here. When determining the best option for you, there are several things your healthcare provider may consider, including:
Where you’ll be getting your treatment: Some options allow you to administer the medication to yourself at home. Others require you to go to your healthcare provider’s office or an infusion center.
How often you’ll need to take your dose: Dose frequency can vary from every day to twice a year. It’s important that you can commit to staying on schedule before starting treatment. Otherwise, your treatment may not work as well.
Potential side effects: Side effects can vary among the different MS medications. Familiarize yourself with possible side effects and ways you could manage them. Your care team should discuss the potential benefits and risks with you.
Cost: If you have insurance, your plan may only cover certain treatment options. You can also check with the manufacturers to see if they offer copay savings cards or patient assistance programs that help pay for the medication.
The bottom line
Infusions and injections for MS can offer flexible dosing schedules and prevent relapses over the long term. However, they differ in terms of side effects, administration time, and whether you can receive the medication at home. When choosing a treatment option for MS, your healthcare provider can be a great resource to help you find the best option for you.
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