Multiple sclerosis treatment is one of the fastest moving areas of medicine.
Thirty years ago, there was not a single approved drug for treating MS. Today, there are 15 medications for relapsing-remitting MS (RRMS), one of which is also the first-ever drug approved for primary-progressive MS (PPMS). Nonetheless, MS can be challenging to treat.
The nature of your illness, how severe it is, and your specific symptoms all come into play when determining which therapy is best for you. Disease-modifying therapies (DMTs) focus on slowing the progression of the disease and changing its course. While none can cure MS, they can reduce the accumulation of lesions in the brain and spinal cord, as well as lessen the frequency and severity of attacks.
They also play a role in reducing the progression of disability. DMTs fall into three categories: injectable medications, those that are given via intravenous (IV) infusion, and those that are taken orally.
Injectables: The injectable DMTs are interferon beta-1a (Avonex, Rebif), interferon beta-1b (Betaseron, Extavia), glatiramer acetate (Copaxone, Glatopa), and peginterferon beta-1a (Plegridy). “The interferons and glatiramer acetate are overall the safest,” says Vijayshree Yadav, M.D., associate professor of neurology at Oregon Health & Science University School of Medicine in Portland, but they may not be as effective as some of the newer drugs.
The most common side effects of interferons include flu-like symptoms and irritation around the injection site.
Infusions: The DMTs administered via IV infusion are alemtuzumab (Lemtrada), mitoxantrone, natalizumab (Tysabri), and ocrelizumab (Ocrevus); the last of these is approved to treat both RRMS and PPMS. Depending on the medication, infusion time can range from as little as five minutes to several hours, and infusions are repeated anywhere from daily to yearly for varying periods of time.
Side effects vary by drug, so be sure to ask your doctor about those.
Oral meds: Some DMTs — teriflunomide (Aubagio), fingolimod (Gilenya), and dimethyl fumarate (Tecfidera) — are taken in pill form. These medications have the advantages of being easy to take and less painful than injections or IVs, which often means people are more willing to stick to them.
There is the risk, however, that “the oral agents can lead to liver function problems and lower white blood cell count,” notes Dr. Yadav.
Other drugs that may be used are geared toward controlling symptoms such as fatigue, depression, muscle stiffness and spasms, and bladder and bowel problems. Additionally, there are a few nondrug therapies that can help take care of some symptoms.
Medication decisions come down to evaluating the balance between a drug’s benefits and risks. “We may choose drugs that have fewer side effects but take longer to begin working in a patient who has a very slowly worsening disease,” explains Robert Glenn Smith, M.D., Ph.D., a neurologist at Houston Methodist Hospital in Texas. “Or we may choose a drug that’s a lot more aggressive in its beneficial effects, but may have more side effects, for somebody with more active disease.”
With so many different treatment options available for MS, there may be some degree of trial and error involved in the process. Try not to get discouraged if it takes a few attempts before finding what works best. Together, you and your doctor will come up with the right treatment or combination of treatments for you.