| Interferon beta | | $62,000 to $67,000 | Decrease in relapses: RR = 0.80; (0.73 to 0.88)20 | Injection site reactions (e.g., edema, inflammation, pain); influenza-like symptoms; leukopenia; elevated liver enzyme levels; depression and suicidal thoughts (increased with preexisting depression, neutralizing antibodies) |
| Interferon beta-1a IM (Avonex) | Intramuscular, weekly | | Decrease in progression: RR = 0.69; (0.55 to 0.87)20 | |
| Interferon beta-1a SC (Rebif) | Subcutaneous, three times per week | | | |
| Interferon beta-1b (Betaseron) | Subcutaneous, every other day | | | |
| Glatiramer (Copaxone) | Subcutaneous, daily | $70,000 | Decrease in relapses: MD = 0.51; (0.22 to 0.81)21 | Injection site reactions, facial flushing, chest tightness, palpitations |
| | | Decrease in disability at two years: MD = 0.33; (0.08 to 0.58)21 | |
| Fingolimod (Gilenya) | Oral, daily | $67,000 | Annualized relapse rate vs. placebo: 0.18 vs. 0.4022 | Bradycardia (contraindicated in recent heart disease or arrhythmia); elevated liver enzyme levels |
| | | Decrease in progression at two years: HR = 0.70; (0.55 to 0.87)22 | Melanoma, macular edema, herpes encephalitis (only occurs at higher doses) |
| Teriflunomide (Aubagio) | Oral, daily | $63,000 | Annualized relapse rate vs. placebo: 0.37 vs. 0.5423 | Alopecia, diarrhea, nausea, decreased white blood cell count, elevated liver enzyme levels, peripheral neuropathy |
| | | Decrease in progression: HR = 0.76; (0.51 to 0.97)23 | |
| Dimethyl fumarate (Tecfidera) | Oral, daily | $68,000 | Annualized relapse rate vs. placebo: 0.17 vs. 0.3624 | Flushing, abdominal pain, lymphocytopenia, elevated liver enzyme levels |
| | | Decrease in progression: HR = 0.62; (0.44 to 0.87)24 | |
| Natalizumab (Tysabri) | Intravenous, once per month | $61,000 | Decrease in relapses: RR = 0.57; (0.47 to 0.69)25 | Infusion reactions, headache, fatigue, progressive multifocal leukoencephalopathy |
| | | Decrease in progression at two years: RR = 0.74; (0.62 to 0.89)25 | |
| Mitoxantrone | Intravenous, every three months | $900 | Decrease in relapses: MD = 0.85; (0.23 to 1.47)26 | Myelosuppression, elevated liver enzyme levels, decreased cardiac function, leukemia |
| | | Decrease in progression: OR = 0.30; (0.09 to 0.99)26 | |
