Multiple Sclerosis

Multiple Sclerosis Treatments

Multiple Sclerosis Treatments

Disease-modifying medications are an important first step to caring for your MS. While they won't directly help your symptoms, they are working behind the scenes to slow down your condition.

That being said, there are a number of therapies to address your challenging MS symptoms. These include medications, rehabilitation strategies, and complementary therapies, like meditation and reflexology.

While there is no cure yet for MS, you can live well with this disease.

In fact, living and dealing with MS may just unleash an inner strength that you never even knew you had.

Disease-Modifying Medications

Scientific studies on disease-modifying medications for MS have found that they not only decrease the number of relapses a person has but also how severe or serious those relapses are. In addition, studies suggest that disease-modifying medications decrease the number and size of lesions (as seen on MRIs of the brain and/or spinal cord) and slow the overall progression of MS.

Due to these studies, the National MS Society strongly advises people newly diagnosed with relapsing forms of MS to begin being treated with a disease-modifying therapy right away. It is believed that the earlier you start, the higher your chance of reducing your disease burden.

There are currently fourteen medications approved by the United States Food and Drug Administration (FDA) for treating relapsing forms of MS (people with relapsing-remitting MS and people with primary progressive or secondary progressive MS who still experience relapses). There is also one medication that is FDA-approved for treating secondary-progressive MS.

 Some of these medications are injected into your fat layer or your muscle, infused through a vein, or taken by mouth.

Injections

There are eight medications that are injected either into a muscle (intramuscular) or underneath the skin into your fatty tissue (subcutaneous). Five of these medications are interferon therapies and include:

Interferons are proteins normally produced by a person's immune system in response to a viral infection. It's believed that for people with MS, interferon therapies modulate a person's immune response, leading to a reduction in myelin-directed attacks within a person's brain and spinal cord. Myelin insulates nerve fibers and, when damaged or destroyed (which occurs with MS), nerves can't communicate to each other.

Interferon therapies are generally well tolerated but may cause pain or redness at the skin site where the medicine is injected. In addition, some people experience flu-like symptoms with this type of therapy, although this tends to get better with time.

Depending on the specific interferon you are taking, your doctor may monitor bloodwork (like liver or blood cell tests) or ask you questions about your medical history before prescribing it. For instance, your doctor may ask if you have a history of depression—which can worsen on interferon therapy.

Two other MS injectable disease-modifying medications are Copaxone and Glatopa (the generic, less expensive form of Copaxone). Like interferon therapy, scientists are not exactly certain how Copaxone or Glatopa work, but it's believed that these medications mimic a protein that makes up myelin, ultimately confusing the immune system from attacking real myelin.

A common side effect of Copaxone and Glatopa is a reaction at the injection site, similar to interferon therapy. Rotating injections sites and using a warm compress prior to injecting can be helpful in minimizing such a reaction.

Also, about 16 percent of people who take Copaxone or Glatopa experience a post-injection reaction that may cause alarming symptoms like a racing heart or anxiety.

The good news is that these symptoms usually disappear within 15 minutes and have no long-term consequences.

A new disease-modifying medication approved by the FDA in 2016 is Zinbryta (daclizumab). This medication is an antibody against a molecule called CD25 on T-cells, infection-fighting cells in your immune system. Zinbryta is believed to reduce MS lesions by reducing the number of T-cells in the body which are known to attack myelin in MS. Other similar antibodies are currently in development.

Zinbryta is given once a month, underneath the skin. Due to the fact that it has the potential to cause severe, life-threatening liver problems and immune system-related problems, Zinbryta can only be prescribed through a special program.

Oral Therapies

There are five oral MS disease-modifying therapies, which is a nice alternative for people who cannot tolerate injections or for people whose MS continues to progress despite interferon therapy and/or Copaxone.

Gilyena (fingolimod) is a pill taken once a day.

It mainly works by preventing certain immune cells from leaving the lymph nodes. Since T-cells are stuck in the lymph nodes, they cannot enter the brain and spinal cord and therefore cause lesions.

There are a number of side effects associated with Gilyena like headaches, flu, diarrhea, and back pain. Gilyena can also cause more serious adverse effects like blurry vision, breathing or liver problems, and infections. Due to the potential of Gilyena to cause a slowing of the heart, monitoring for six hours after the first dose is required in a healthcare setting.

Another oral MS medication is Tecfidera (dimethyl fumarate)—a pill taken twice daily. This medication activates a pathway in the body that is normally turned on when cells are stressed. In other words, it helps protect cells, although precisely how this works in a person with MS is unclear.

Common side effects of Tecfidera are flushing, nausea, diarrhea, and stomach pain. Serious adverse effects include a severe allergic reaction, the development of progressive multifocal leukoencephalopathy (a life-threatening brain condition), and a lowering of a person's infection-fighting cells.

Aubagio (teriflunomide) is taken once daily and may cause headaches, hair thinning, diarrhea, nausea, or abnormal liver blood tests. Aubagio works by suppressing the immune system, so it can predispose people to infections.

Since Aubagio can cause liver failure, your doctor will check your liver blood tests prior to starting the medication and then periodically afterward. Aubagio is also a pregnancy category X drug, so it cannot be used while a woman is pregnant or if she is planning on becoming pregnant.

Infusions

Lemtrada (alemtuzumab) is an infused MS disease-modifying medication given for five days in a row and then three days in a row one year later. Due to the fact that there are a number of FDA warnings linked to Lemtrada, it can only be given through a special program and is reserved for people with MS who have had an inadequate response to two or more other disease-modifying medications.

Another infused disease-modifying medication is Novantrone (mitoxantrone), a chemotherapy drug that is given every three months. In addition to treating relapsing forms of MS, mitoxantrone can also be used to treat secondary progressive MS. Mitoxantrone can cause heart damage, so it can only be given a limited number of times. It has also been linked to the development of acute myeloid leukemia (AML).

A third infused MS disease-modifying medication is Tysabri (natalizumab), which is given every 28 days. It can only be administered in an approved infusion center due to the risk of developing progressive multifocal leukoencephalopathy (PML)—a potentially fatal infection of the brain linked to the JC virus.

Upcoming Therapies

The good news is that scientists are learning more and more about MS each day, which also means that novel, better therapies are emerging. Some potential medications (like certain monoclonal antibodies) are in the earlier phases of study.  Other therapies, like stem cell transplantation and estriol, are more controversial—mostly because there are not large scientific studies to back up their use.

Finally, one evolving area of research is the role of diet in MS, including vitamin D supplementation and gut bacteria. While there is no specific diet (like the Swank diet) that people with MS should absolutely follow, an overall healthy diet that's rich in fiber and low in fat is recommended by the National MS Society.

Treating Symptoms

While it's important to be on a disease-modifying medication for your MS, it's also important to maximize your comfort and functioning. In fact, coping with MS is a daily process for most people, requiring a thoughtful plan for how you can manage the day optimally under the weight of your limitations.

The good news is that there are ample therapies to help a person with MS or their loved one feel well and manage uncomfortable or burdening symptoms. These therapies include:

  • Medications
  • Lifestyle Habits
  • Rehabilitation strategies
  • Complementary therapies

One symptom that is especially debilitating for many people with MS is fatigue—an all-encompassing, brutal exhaustion that can make simple activities like getting dressed in the morning or concentrating on a movie challenging and unpleasant.  But there are numerous strategies to combat it , including :

Like fatigue, there are a variety of therapies for other MS-related symptoms. For example, complementary therapy meditation can be used to treat MS-related pain as can medication like gabapentin for nerve-related pain and muscle relaxants for muscle-related pain (spasticity).

Seeing a specialist can also be helpful for managing your symptoms. A urologist or gynecologist may be able to counsel or provide therapies for managing MS-related sexual dysfunction, like erectile dysfunction in men or reduced vaginal/clitoral sensation in women.  A neuropsychologist may help a person who is struggling with cognitive dysfunction. For people with MS who require assistive walking devices, a physical and occupational therapist can be instrumental in maximizing independence and functioning within your home and at work.

A Word From Verywell

Try to be patient as you and your MS healthcare team sort out the best treatment regimen—a delicate balance between slowing down your MS while minimizing side effects and maximizing how you feel. Remember MS is a unique disease, so what works for a friend or a loved one may not be best for you.

Also, as your disease progresses or improves after a relapse, your symptoms and treatment decisions may change. Try to remain flexible and communicate your thoughts and concerns with your neurologist. Continue to stay strong on your MS journey.

Sources:

Bloomgren G et al. Risk of natalizumab-associated progressive multifocal leukoencephalopathy. N Engl J Med. 2012 May 17;36620):1870-80.

Burness CB & Deeks ED. Dimethyl fumarate: a review of its use in patients with relapsing-remitting multiple sclerosis. CNS Drugs. 2014 Apr;28(4):373-87.

Fazekas F et al. How does fingolimod (Gilyena) fir in the treatment algorithm for highly active relapsing-remitting multiple sclerosis? Front Neurol. 2013;4:10.

Lycke J. Monoclonal antibody therapies for the treatment of relapsing-remitting multiple sclerosis: differentiating mechanisms and clinical outcomes. Ther Adv Neurol Disord. 2015 Nov;8(6):274-293.

National MS Society. Disease-Modifying Therapies for MS.

Namjooyan, F., Ghanavati, R., Majdinasab, N., Jokari, S., & Janbozorgi, M. (2014). Uses of complementary and alternative medicine in multiple sclerosis. Journal of Traditional Complementary Medicine, Jul-Sep;4(3):145-52.

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