Zinbryta (daclizumab)

Other names: BIIB019, Zenepax

Zinbryta was a disease modifying drug (DMD) used to treat relapsing remitting MS.

You could self-inject Zinbryta under the skin once a month to reduce the number and severity of relapses. It reduced the number of relapses by about one half (50%) compared to taking placebo.

Common side effects included skin rash, depression and increased levels of liver enzymes which could lead to liver problems.

Less common, but more severe side effects included serious infections, serious and widespread skin rash, liver damage and inflammation of the bowel (colitis).

The risk of liver problems was reviewed by the European Medicines Agency and in October 2017 they recommended that Zinbryta only be used in people where two other DMDs had been unsuccessful and for whom there were no other DMD options. They also stated that Zinbryta must not be used in patients with pre-existing liver disease. In March 2018 further cases of severe side effects meant that Zinbryta was withdrawn completely and is no longer being prescribed.

What was Zinbryta used for in MS?

Zinbryta was a disease modifying drug (DMD) for relapsing remitting MS. Zinbryta was classed as a more effective (category 1.2) DMD; in clinical trials people taking Zinbryta had about 50% fewer relapses than people taking placebo. MRI scans also showed people taking Zinbryta had fewer, smaller or no new active MS (lesions). Zinbryta may also have slowed down the build-up of disability associated with MS.

How did Zinbryta work?

Zinbryta binds to immune cells (lymphocytes or white blood cells) and reduces the activity of cells involved in the immune attack that causes damage associated with MS.

Zinbryta research

Evidence for the effectiveness of Zinbryta came from two large clinical trials.

SELECT - Zinbryta compared to placebo

SELECT was a one year study which compared two doses of Zinbryta and placebo in approximately 600 patients with relapsing remitting MS. Compared to placebo, the drug reduced the number of relapses in one year by about 50% and reduced disability progression by about 50%.

DECIDE - Zinbryta compared to Avonex

This study compared Zinbryta to Avonex (interferon beta 1a) in 1841 people over two years. Compared to Avonex, Zinbryta reduced the number of relapses in one year by 46% and reduced the number of lesions seen on MRI by 54%. The effect on increasing disability was less clear cut, with Zinbryta only slightly more effective than Avonex at reducing the risk of increased disability lasting 3 months.

Find out more

National Institute for Health and Care Excellence (NICE)
Daclizumab for treating relapsing-remitting multiple sclerosis
NICE Technology Appraisal Guidance 441
Full guideline (link is external)
Scottish Medicines Consortium
Advice: daclizumab (Zinbryta) - April 2017
Full guideline (link is external)
Gold R, et al.
Daclizumab high-yield process (HYP) in relapsing-remitting multiple sclerosis (SELECT): a randomised, double-blind, placebo-controlled trial.
Lancet 2013;381:2167-2175.
Summary (link is external)
Kappos L, et al.
Daclizumab HYP versus interferon beta-1a in relapsing remitting multiple sclerosis.
New England Journal of Medicine 2015;373:1418-1428.
Full article (link is external)
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