Table 1

List of DMTs and respective characteristics

DMT agent	Group	Mechanism of action	Indications	Route of administration
Azathioprine	Suppressing	Purine antagonist that impairs the synthesis of DNA, RNA and proteins, and damages T-cell lymphocyte function.	Renal homotransplantation Rheumatoid arthritis	Oral tablet
Cladribine	Suppressing	Nucleoside analogue disrupts DNA synthesis and chain termination. It specifically targets and damages lymphocytes and monocytes, exhibiting cytotoxic effects.	MS Hairy cell leukaemia	Oral tablet (MS) Intravenous (hair cell leukaemia)
Cyclophosphamide	Suppressing	Alkylating agent that prevents DNA replication and transcription through DNA crosslinking.	Cancer: lymphoblastic leukaemia, myeloid leukaemia, breast cancer, Hodgkin lymphoma, mycosis fungoides, multiple myeloma, neuroblastoma, non-Hodgkin lymphomas, ovarian adenocarcinoma, and retinoblastoma Nephrotic syndrome	Oral tablet Intravenous
Methotrexate	Suppressing	Inhibits dihydrofolate reductase and thymidylate synthase involved in DNA development and cell metabolism; reduces inflammation by suppressing the production of B and T cells.	Acute lymphoblastic leukaemia Breast cancer Cutaneous T cell lymphoma Gestational trophoblastic neoplasia Head and neck squamous cell carcinoma Meningeal leukaemia Non-Hodgkin lymphomas Osteosarcoma Polyarticular juvenile idiopathic arthritis, psoriasis, rheumatoid arthritis	Oral tablet Oral solution Intravenous
Mitoxantrone	Suppressing	Affect cells in the CNS by intercalating into DNA; impairs DNA replication and DNA-dependent RNA synthesis; can bind to topoisomerase II, causing DNA repair to be inhibited.	MS (US only) Acute myeloid leukaemia Prostate cancer	Intravenous
Teriflunomide	Suppressing	Inhibits the enzyme dihydroorotate dehydrogenase, involved in mitochondrial de novo pyrimidine synthesis; reduces number of circulating lymphocytes.	MS	Oral tablet
Dimethyl fumarate	Modulating	Modulates levels of Nrf2 and glutathione in T cells; induces antioxidant effect by upregulating antioxidant response genes.	MS	Oral capsule (delayed release)
Glatiramer acetate	Modulating	Amino acid polymer; shifts the immune response from a pro-inflammatory state to regulatory, non-inflammatory state; reduces inflammation in the CNS.	MS	Subcutaneous injection
Interferon β	Modulating	Regulates the migration and retention of immune cells; decreases T cell activation and proliferation; decreases the migration of lymphocytes across the blood-brain barrier.	MS	Subcutaneous injection
Fingolimod	Sequestering	Sphingosine 1 phosphate receptor modulator; reduces T lymphocytes in circulation.	MS	Oral capsule
Natalizumab	Sequestering	Monoclonal antibody; selective adhesion molecule inhibitor, prevents adhesion of leukocytes to endothelial cells.	MS Crohn’s disease	Intravenous
Alemtuzumab	Depleting	Monoclonal antibody; binds on CD52 (cell surface antigen) present on T and B lymphocytes; antibody-dependent lysis of malignant cells.	MS B-cell chronic lymphocytic leukaemia	Intravenous
Ocrelizumab	Depleting	Monoclonal antibody; targets CD20-expressing B cells; depletes CD20 positive B cells.	MS	Intravenous
Rituximab (off-label)	Depleting	Monoclonal antibody; targets CD20-expressing B cells; promotes cell lysis.	Chronic lymphocytic leukaemia Granulomatosis with polyangiitis Microscopic polyangiitis CD20-positive non-Hodgkin lymphomas Rheumatoid arthritis	Intravenous Subcutaneous injection
Minocycline (off-label)	Minocycline	Tetracycline antibiotic; binds to the bacterial 30S ribosomal subunit and interferes with protein synthesis.	Acne vulgaris Infections of susceptible microorganisms, bacterial infections	Oral capsule Subgingival powder (extended release)

CNS, central nervous system; DMT, disease-modifying therapy; MS, multiple sclerosis.