Editing Multiple sclerosis (section)

==== Adverse effects ====
[[File:Copaxone Injection Site Reaction.JPG|thumb|Irritation zone after injection of glatiramer acetate]]
The [[disease-modifying treatment]]s have several adverse effects. One of the most common is irritation at the injection site for glatiramer acetate and the interferons (up to 90% with subcutaneous injections and 33% with intramuscular injections).<ref name=Rice2001 /><ref name=Balak2012>{{cite journal | vauthors = Balak DM, Hengstman GJ, Çakmak A, Thio HB | title = Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: a systematic review | journal = Multiple Sclerosis | volume = 18 | issue = 12 | pages = 1705–17 | date = December 2012 | pmid = 22371220 | doi = 10.1177/1352458512438239 | hdl = 1765/73097 | hdl-access = free }}</ref> Over time, a visible dent at the injection site, due to the local destruction of fat tissue, known as [[lipoatrophy]], may develop.<ref name=Balak2012 /> Interferons may produce [[flu-like symptoms]];<ref name="pmid17131933">{{cite journal | vauthors = Sládková T, Kostolanský F | title = The role of cytokines in the immune response to influenza A virus infection | journal = Acta Virologica | volume = 50 | issue = 3 | pages = 151–62 | year = 2006 | pmid = 17131933 }}</ref> some people taking glatiramer experience a post-injection reaction with flushing, chest tightness, heart palpitations, and anxiety, which usually lasts less than thirty minutes.<ref>{{cite journal | vauthors = La Mantia L, Munari LM, Lovati R | title = Glatiramer acetate for multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD004678 | date = May 2010 | pmid = 20464733 | doi = 10.1002/14651858.CD004678.pub2 }}</ref> More dangerous but much less common are [[hepatotoxicity|liver damage]] from interferons,<ref name="pmid15592724">{{cite journal | vauthors = Tremlett H, Oger J | title = Hepatic injury, liver monitoring and the beta-interferons for multiple sclerosis | journal = Journal of Neurology | volume = 251 | issue = 11 | pages = 1297–303 | date = November 2004 | pmid = 15592724 | doi = 10.1007/s00415-004-0619-5 | s2cid = 12529733 }}</ref> [[systolic dysfunction]] (12%), [[infertility]], and [[acute myeloid leukemia]] (0.8%) from mitoxantrone,<ref name=CochMit2013 /><ref name="pmid19882365">{{cite journal | vauthors = Comi G | title = Treatment of multiple sclerosis: role of natalizumab | journal = Neurological Sciences | volume = 30 | issue = S2 | pages = S155-8 | date = October 2009 | pmid = 19882365 | doi = 10.1007/s10072-009-0147-2 | series = 30 | s2cid = 25910077 }}</ref> and [[progressive multifocal leukoencephalopathy]] occurring with natalizumab (occurring in 1 in 600 people treated).<ref name="Tsang20112"/><ref>{{cite journal | vauthors = Hunt D, Giovannoni G | title = Natalizumab-associated progressive multifocal leucoencephalopathy: a practical approach to risk profiling and monitoring | journal = Practical Neurology | volume = 12 | issue = 1 | pages = 25–35 | date = February 2012 | pmid = 22258169 | doi = 10.1136/practneurol-2011-000092 | s2cid = 46326042 }}</ref>

Fingolimod may give rise to [[hypertension]] and [[bradycardia|slowed heart rate]], [[macular edema]], elevated liver enzymes, or a [[lymphopenia|reduction in lymphocyte levels]].<ref name=LaMantia2016 /><ref name="pmid22014437">{{cite journal | vauthors = Killestein J, Rudick RA, Polman CH | title = Oral treatment for multiple sclerosis | journal = The Lancet. Neurology | volume = 10 | issue = 11 | pages = 1026–34 | date = November 2011 | pmid = 22014437 | doi = 10.1016/S1474-4422(11)70228-9 | s2cid = 206160178 }}</ref> Tentative evidence supports the short-term safety of teriflunomide, with common side effects including headaches, fatigue, nausea, hair loss, and limb pain.<ref name=He2016 /> There have also been reports of liver failure and PML with its use and it is [[Teratology|dangerous for fetal development]].<ref name="pmid22014437" /> Most common side effects of dimethyl fumarate are flushing and gastrointestinal problems.<ref name=Xu2015 /><ref name=fumarate>{{cite press release|url=http://www.biogenidec.com/press_release_details.aspx?ID=5981&ReqId=1801165|title=Biogen Idec's TECFIDERA™ (Dimethyl Fumarate) Approved in US as a First-Line Oral Treatment for Multiple Sclerosis|publisher=Biogen Idec|date=27 March 2013|access-date=4 June 2013|url-status=dead|archive-url=https://web.archive.org/web/20130512021453/http://www.biogenidec.com/press_release_details.aspx?ID=5981&ReqId=1801165|archive-date=12 May 2013}}</ref><ref name="pmid22014437" /> While dimethyl fumarate may lead to a [[neutropenia|reduction in the white blood cell count]] there were no reported cases of opportunistic infections during trials.<ref name=fumarateNDA>{{cite web |title=NDA 204063 – FDA Approved Labeling Text |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/204063lbl.pdf |date=27 March 2013 |access-date=5 April 2013 |publisher=US Food and Drug Agency |url-status=live |archive-url=https://web.archive.org/web/20131004220910/http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/204063lbl.pdf |archive-date=4 October 2013 }}<br />{{cite web |title=NDA Approval |date=27 March 2013 |url=http://www.accessdata.fda.gov/drugsatfda_docs/appletter/2013/204063Orig1s000ltr.pdf |access-date=5 April 2013 |publisher=US Food and Drug Agency |url-status=dead |archive-url=https://web.archive.org/web/20131004220451/http://www.accessdata.fda.gov/drugsatfda_docs/appletter/2013/204063Orig1s000ltr.pdf |archive-date=4 October 2013 }}</ref>