title: Update on monitoring and adverse effects of first generation disease modifying therapies and their recently approved versions in relapsing forms of multiple sclerosis.
abstract: As of April 2015, 13 disease modifying therapies (DMTs) have been approved by the Food and Drug Administration. The older agents continue to be utilized across the globe, especially in developing countries where many newer DMTs are still not available. Even though first generation DMTs have modest efficacy they have long term safety profile, and are considered safer than the second generation DMTs.
  
  
  
  A PEGylated interferon beta-1a preparation that is administered subcutaneously every 2 weeks was also recently approved. Less frequent administration potentially reduced administration associated side effects and may improve adherence and compliance. The polyethylene glycol is also thought to make the drug less immunogenic. Glatopa (a glatiramer acetate bioequivalent), now represents the first available generic alternative of a DMT for multiple sclerosis. Its dosing, route of administration, and side effects are the same as for Copaxone.
  
  
  
  In this article, we review the potential adverse effects and recommended laboratory studies as part of the monitoring strategy following initiation of various first generation DMTs and their recently approved versions.
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Divyanshu
authors.initials: D
authors.lastname: Dubey
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Cano
authors.forename: Olaf
authors.initials: O
authors.lastname: Stüve
mesh_terms: D016903:Drug Monitoring / Q000379:methods*; D000068717:Glatiramer Acetate / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016899:Interferon-beta / Q000627:therapeutic use; D008942:Mitoxantrone / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000188:drug therapy; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000188:drug therapy*; D064926:Neurophysiological Monitoring / Q000379:methods*
chemical_list: D007155:Immunologic Factors; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D008942:Mitoxantrone