Indications As Approved by Health Canada

• For the treatment of relapsing forms of MS to slow the progression of disability, decrease the frequency of MS attacks, and reduce the number and volume of brain lesions seen on MRI.


• For the treatment of people at risk of developing clinically definite MS (CDMS), so as to delay the onset of clinically definite MS and to decrease the number and volume of active brain lesions on MRI. Before Avonex is initiated, people at risk of developing CDMD must have brain lesions on MRI and other possible diagnoses must be ruled out.

• Flu-like symptoms following injection, which lessen over time for many. (See “Managing side effects”.)


• Less common: depression, mild anemia, liver abnormalities, allergic reactions, heart problems.

• Individuals with a history of depression, a seizure disorder, or cardiac problems should be closely monitored while on this medication;


• All patients on this medication should have baseline liver function testing and periodic testing thereafter; Periodic blood testing is recommended to check for a possible reduction in infection-fighting blood cells, red blood cells, and cells that help blood to clots;


• Rare but significant allergic reactions have been reported to this medication.

• For the treatment of people with relapsing-remitting MS who are ambulatory (able to walk) to reduce the frequency of attacks.


• For the treatment of secondary-progressive MS to slow the progression of disability and to reduce the frequency of attacks.


• For the treatment of people at risk of developing clinically definite MS (CDMS) accompanied by at least two lesions on MRI to delay the progression to CDMS. Before Betaseron is initiated, alternative diagnoses must be ruled out.

• Flu-like symptoms following injection, which lessen over time for many. (See “Managing side effects”) Injection site reactions, about 5% of which need medical attention.


• Less common: allergic reactions, depression, liver abnormalities, low white blood cell counts.

• Individuals with a history of depression or a seizure disorder should be closely monitored while on this medication; This medication should be used with caution in people with depression;


• This treatment should be used with caution in patients with pre-existing significant cardiac disease;


• Rare but significant allergic reactions have been reported with this medication;


• Because skin infections or areas of severe skin damage can occur, injection sites should be rotated on a regular basis.

• For the treatment of relapsing-remitting MS who are ambulatory (able to walk) to reduce the frequency of attacks and to reduce the number and volume of active brain lesions identified on MRI.


• For the treatment of people at risk of developing clinically definite MS (CDMS) so as to delay the onset of CDMS, and to decrease the number and volume of active brain lesions and overall disease burden on MRI. Before Copaxone is initiated, people at risk of developing CDMS must have brain lesions on MRI and other possible diagnoses must be ruled out.

• Injection site reactions.


• Less common: vasodilation (dilation of blood vessels); chest pain; a reaction immediately after injection, which includes anxiety, chest pain, palpitations, shortness of breath, and flushing. This lasts 15-30 minutes, typically passes without treatment, and has no known long-term effects.

• Copaxone has been associated with an Immediate Post-Injection Reaction that includes at least two of the following: flushing, chest pain, palpitations, anxiety, shortness of breath, constriction of the throat, and transient skin eruptions. These symptoms generally disappear spontaneously after about 15 minutes and have no long-term effects. This post-injection reaction generally occurs after the first few months of treatment and may occur more than once in a given individual.


• Transient chest pain — without any long-term effects — may also occur one or more times, either as part of the post-injection reaction or separately.


• Permanent depressions under the skin at injection sites can occur because of destruction of the fatty tissue. In addition, areas of severe skin damage can occur. For these reasons, careful rotation of injection sites is recommended so that no single area is injected more than one time per week.

• For the treatment of relapsing-remitting MS who are ambulatory (able to walk) to reduce the frequency of attacks.


• For the treatment of secondary-progressive MS to slow the progression of disability and to reduce the frequency of attacks.


• For the treatment of people with a single demyelinating event accompanied by at least two clinically silent lesions typical of MS on MRI to delay progression to definite MS. Before initiating treatment with Extavia alternate diagnosis should first be excluded.

• Flu-like symptoms following injection, which lessen over time for many. (See “Managing side effects”.) Injection site reactions, about 5% of which need medical attention.


• Less common: allergic reactions, depression, liver abnormalities, low white blood cell counts.

• Individuals with a history of depression or a seizure disorder should be closely monitored while on this medication; This medication should be used with caution in people with depression;


• This treatment should be used with caution in patients with pre-existing significant cardiac disease;


• Rare but significant allergic reactions have been reported with this medication;


• Because skin infections or areas of severe skin damage can occur, injection sites should be rotated on a regular basis.

• For the treatment of relapsing forms of MS to reduce the frequency of attacks and to slow the progression of disability. Gilenya is indicated as a second-line therapy for people who have not responded adequately to other first-line disease-modifying therapies or who are unable to tolerate them.

• Headache, flu, diarrhea, back pain, liver enzyme elevations and cough.


• Less common but serious side effects can also occur including: slowed heart rate following first dose, infections, swelling in the eye.

• If a person has not had chicken pox (varicella), his or her doctor may recommend the varicella vaccine prior to starting this treatment;


• Because Gilenya can cause a person’s heart rate to drop after the first dose, patients will be monitored for six hours in the doctor’s office after taking the first dose of medication;


• Because this medication reduces the number of white blood cells, leading to an increased risk of infection, a blood test to measure white blood cell count is recommended prior to starting treatment;


• A vision test is recommended prior to starting treatment and 2–3 months later to look for evidence of macular swelling in the eye;


• Because Gilenya can cause liver problems, a liver function test is recommended prior to starting treatment.

• For the treatment of relapsing forms of MS (relapsing-remitting MS and secondary-progressive MS) to slow the progression of disability, decrease the frequency of MS attacks, and reduce the number and volume of brain lesions seen on MRI.


• Although Rebif did not affect progression of disability in SPMS, clinical trials have shown that people with SPMS with relapses experience benefits with respect to relapses and MRI disease activity compared to those receiving placebo.

• Flu-like symptoms following injection, which lessen over time for many. (See “Managing side effects”.) Injection site reactions.


• Less common: liver abnormalities, depression, allergic reactions, and low red or white blood cell counts.

• Individuals with a history of depression or a seizure disorder should be closely monitored while on this medication;


• All patients on this medication should have baseline liver function testing and periodic testing thereafter;


• Periodic blood testing is recommended to check for a possible reduction in infection fighting blood cells, red blood cells, and cells that help blood to clots;


• Rare but significant allergic reactions have been reported with this treatment.

• For the treatment of people with relapsing-remitting MS to reduce the frequency of relapses, delay the progression of disability and reduce the number and volume of brain lesions seen on MRI.

*Tysabri is intended as a monotherapy (not combined with other disease-modifying therapies). It is generally recommended for people with MS who have not responded adequately to other first-line disease-modifying therapies or who are unable to tolerate them. This is because of an increased risk of progressive multifocal leukoencephalopathy (PML).

• Headache, fatigue, urinary tract infections, depression, lower respiratory tract infections, joint pain, and chest discomfort.


• Less common: allergic or hypersensitivity reactions within two hours of infusion (dizziness, fever, rash, itching, nausea, flushing, low blood pressure, difficulty breathing, chest pain), liver abnormalities. People taking Tysabri must be monitored for PML.

• Tysabri (natalizumab) is a laboratory-produced monoclonal antibody that is given by intravenous (IV) infusion every four weeks.


• Tysabri cannot be infused at home, so your doctor will help you find an infusion center that is convenient to your home.


• All medications delivered by IV infusion pose risks of bruising, vein damage, blood clots and more. Infusions must be managed by a well-trained medical professional who is qualified to administer them.


• When talking with your health care professional about starting treatment with Tysabri, it is important to consider the following information: Individuals taking Tysabri are at increased risk for a rare, generally fatal brain disease called progressive multifocal leukoencephalopathy (PML), which is caused by the common JC virus.