Infusion Therapy for Multiple Sclerosis

Established Infusion Therapies for MS

The American Academy of Neurology recommends Natalizumab as an escalation therapy when patients experience breakthrough disease activity on first-line therapy, particularly if JC virus antibody-negative 1
The National Multiple Sclerosis Society indicates Ocrelizumab is used for both relapsing-remitting MS and primary progressive MS, representing the only specific treatment approved for primary progressive disease 2
Alemtuzumab is considered a high-efficacy DMT option for escalation therapy in highly active MS, according to the Multiple Sclerosis Association of America 1

The European Committee for Treatment and Research in Multiple Sclerosis suggests high-efficacy infusion DMTs should be considered in patients with highly active MS who have failed standard or high-efficacy DMT for ≥6 months 1
Patients with markers of aggressive disease, including frequent relapses, incomplete recovery from relapses, high frequency of new MRI lesions, and rapid onset of disability, should be considered for high-efficacy infusion DMTs, as recommended by the National Institute for Health and Care Excellence 3, 1
The American College of Neurology recommends considering high-efficacy infusion DMTs after failure of a single high-efficacy DMT following a meaningful treatment period, particularly in aggressive disease 3

The Multiple Sclerosis International Federation recommends baseline MRI and repeat imaging within 3-12 months depending on disease characteristics, then at least annually for stable patients 2
For natalizumab specifically, JC virus antibody testing is essential due to progressive multifocal leukoencephalopathy (PML) risk, according to the Food and Drug Administration 1
Regular monitoring for infusion reactions is necessary, which can range from mild (nausea, fever, erythema) to severe (hypotension, respiratory distress, bronchospasm), as suggested by the American Academy of Dermatology 4
Pretreatment with acetaminophen and diphenhydramine can mitigate infusion reactions, as recommended by the Journal of the American Academy of Dermatology 4

The European Multiple Sclerosis Platform advises against delaying referral for high-efficacy therapy in patients with aggressive disease markers—early escalation improves outcomes 3, 1
Ensure appropriate patient selection through comprehensive screening including liver function, bone marrow assessment, viral profiles, and cardiac evaluation before initiating certain high-efficacy infusion therapies, as recommended by the American College of Neurology 1
Missing infusion appointments increases the risk of subsequent infusion reactions; the next infusion should be administered more slowly with appropriate pretreatment, according to the American Academy of Dermatology 4