Multiple sclerosis (MS) is an autoimmune disease that damages the nerve cells in your central nervous system (CNS).
Your CNS is composed of your brain, spinal cord, and optic nerves (the nerves in your eyes).
MS causes symptoms that gradually get worse, as well as symptoms that come on suddenly after a period of being controlled. This sudden appearance of symptoms is called a relapse.
There’s no cure for MS, and the damage it causes can’t be reversed. But certain medications can help you manage the condition.
Condition management focuses on medication that can treat relapses, as well as change the disease to lower damage and disability. It also involves other drugs that treat the symptoms or complications of MS.
The Food and Drug Administration (FDA) has approved the following drugs for the treatment of MS:
- Oral drugs: cladribine (Mavenclad), dimethyl fumarate (Tecfidera), diroximel fumarate (Vumerity), fingolimod (Gilenya), monomethyl fumarate (Bafiertam), ozanimod (Zeposia), siponimod (Mayzent), teriflunomide (Aubagio), ponesimod (Ponvory)
- Injections: interferon beta-1a (Avonex, Rebif), interferon beta-1b (Betaseron, Extavia), glatiramer acetate (Copaxone, Glatopa), peginterferon beta-1a (Plegridy), ofatumumab (Kesimpta)
- Infusions: alemtuzumab (Lemtrada), mitoxantrone hydrochloride, natalizumab (Tysabri), ocrelizumab (Ocrevus)
There are several types of disease-modifying therapies (DMTs) that work to help change the course of MS. The length of treatment with these medications can range from a few months to years, depending on how effective the medications are for you.
A doctor or healthcare professional may recommend switching between these drugs throughout the course of your treatment. This will depend on how effectively each drug manages your disease and how you tolerate the side effects.
If you switch to a different DMT, a doctor will take note of whether you develop new lesions.
The FDA has approved 12 MS medications that are administered by injection or infusion.
Interferon beta products
These drugs include:
- interferon beta-1a (Avonex, Rebif)
- peginterferon beta-1a (Plegridy)
- interferon beta-1b (Betaseron, Extavia)
They help change relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS) in people wiht active disease — that is, a relapse has occurred, or new lesions have appeared on an MRI scan.
They also treat clinically isolated syndrome (CIS), a one-off episode of neurological symptoms. CIS can progress to MS and is sometimes categorized as a type of MS.
These drugs are made up of proteins that keep certain white blood cells (WBCs) from entering your brain and spinal cord. These WBCs are thought to damage the myelin that forms a protective coating over your nerve fibers.
Therefore, preventing these WBCs from moving into your brain and spinal cord can help slow their damage and lower the number of relapses you have.
You inject these drugs yourself. Your healthcare professional will show you how to do this. The number of injections depends on the drug:
- Rebif: three times per week
- Betaseron: every other day
- Extavia: every other day
- Avonex: once per week
- Plegridy: every 2 weeks
Glatiramer acetate (Copaxone)
Glatiramer acetate (Copaxone) is a manufactured substance that resembles a basic protein of natural myelin. It’s thought to work by prompting the WBCs to attack the substance instead of the myelin cells.
You inject this drug yourself once per day or three times per week, depending on your dosage. A healthcare professional will show you how.
People who receive injections three times per week should ensure that at least 48 hours elapse between their injections.
The FDA has also approved Glatopa, a generic form of Copaxone.
Natalizumab (Tysabri) is an infused medication that may block damaged T lymphocytes from moving into your brain and spinal cord.
A healthcare professional gives you this drug as an intravenous (IV) infusion. The infusion takes about an hour, and you’ll get it every 4 weeks.
Taking natalizumab (Tysabri) can increase your chance of getting progressive multifocal leukoencephalopathy (PML). PML is a rare brain infection that usually leads to death or severe disability. Currently, there’s no known treatment for PML.
It tends to happen in people with weakened immune systems, and your risk may be higher if you take other medication that weakens your immune system. But people who take natalizumab (Tysabri) on its own can still develop PML.
Mitoxantrone hydrochloride (Novantrone)
Mitoxantrone hydrochloride (Novantrone) is an infused medication that was originally used to treat cancer. Now it’s also prescribed to treat people with MS. It suppresses the immune system cells that are thought to attack your myelin cells. This medication is only available as a generic drug.
It’s used to treat SPMS or worsening RRMS in instances where other drugs haven’t worked. It has a high risk of serious side effects, so it’s only appropriate for people with these more severe forms of MS. You can only receive a limited amount of the drug during your lifetime.
A healthcare professional gives you this drug as a short IV infusion once every 3 months until the maximum lifetime dose is reached. The infusion should only take 5 to 15 minutes.
Alemtuzumab (Lemtrada) is approved for people with relapsing forms of MS, including RRMS and active SPMS. It’s intended for people who’ve tried at least two other MS medications but found that treatment was unsuccessful or caused intolerable side effects.
It works by lowering the number of specific B and T lymphocytes in your body. This action may decrease the inflammation of and damage to your nerve cells.
Alemtuzumab is given as a 4-hour IV infusion. To start, you receive this drug once per day for 5 days. Then, 12 months after your first treatment course, you receive it once per day for 3 more days.
Ocrelizumab (Ocrevus) is the newest infusion treatment for MS. It was approved by the FDA in 2017.
It’s the first drug used to treat primary progressive MS. It’s also used to treat CIS and relapsing forms of MS.
Ocrelizumab appears to work by targeting and ultimately lowering your number of B lymphocytes. B lymphocytes are responsible for the damage and repair of your myelin sheaths.
Ocrelizumab is given as an IV infusion. To begin, you’ll receive it in two 300-mg infusions separated by 2 weeks. After that, you’ll receive it in 600-mg infusions every 6 months.
You’ll also receive a corticosteroid and an antihistamine on the day of each infusion to lower your risk of a reaction to the medication.
Ofatumumab (Kesimpta) was approved by the FDA in August 2020 and is the newest treatment for MS.
Like ocrelizumab (Ocrevus), it also works by targeting harmful B lymphocytes and lowering the overall number of them.
Ofatumumab is given as an injection once per week for the first 3 weeks. After a 1-week break, the drug is given as a monthly injection.
The FDA has approved eight oral medications for the treatment of MS.
Fingolimod (Gilenya) comes as an oral capsule that you take once per day.
It was the first oral medication approved by the FDA to treat RRMS. It’s also used to treat CIS and active SPMS.
Fingolimod causes the damaging WBCs to remain within your lymph nodes, which are nodes throughout your body that store white blood cells. This lowers the chance that they’ll enter your brain or spinal cord and cause damage.
Teriflunomide (Aubagio) is an oral tablet you take once daily.
Teriflunomide works by blocking an enzyme that’s needed by the damaging WBCs. As a result, teriflunomide helps decrease your number of these cells, which lowers the damage they can inflict.
Dimethyl fumarate (Tecfidera)
Dimethyl fumarate (Tecfidera) is an oral capsule that you take twice per day.
The exact mechanism of this drug is unknown.
It appears to work by interfering with the activity of certain immune system cells and chemicals to lower your risk of an MS relapse. It may also have antioxidant properties that help protect against brain and spinal cord damage.
Diroximel fumarate (Vumerity)
Diroximel fumarate (Vumerity) is an oral capsule you take twice daily.
Diroximel fumarate has the same active ingredient as dimethyl fumarate (Tecfidera), and it works the same way. This means that it may also have antioxidant properties and interfere with the activity of certain immune system cells and chemicals.
Monomethyl fumarate (Bafiertam)
Monomethyl fumarate (Bafiertam) is an oral capsule that you take twice per day. It was approved by the FDA in April 2020.
Monomethyl fumarate is a bioequivalent of dimethyl fumarate (Tecfidera). Like dimethyl fumarate, monomethyl fumarate may have antioxidant properties and appears to work by interfering with the activity of certain immune system cells and chemicals.
Cladribine (Mavenclad) is a pill that you take for a total of 16 or 20 days over the course of 2 years. You’ll have treatment for 2 weeks per year, with each session lasting 4 or 5 days. There’s a 1-month break in between the 2 weeks of treatment.
It’s approved for people with relapsing forms of MS, including RRMS and active SPMS. It’s intended for people who’ve tried at least one other MS medication but found that treatment was unsuccessful or caused intolerable side effects.
It may work by lowering the number of harmful B and T lymphocytes that you have.
Siponimod (Mayzent) is an oral tablet you take once daily.
It’s believed to work by blocking certain inflammatory cells from leaving your lymph nodes. This action limits the amount of nerve damage that they can inflict.
Ozanimod (Zeposia) is an oral capsule you take once daily.
It’s believed to work by blocking immune cells from leaving your lymph nodes and entering your CNS.
Fingolimod (Gilenya) is currently the only DMT that’s approved by the FDA for use in children. It’s safe for use in people ages 10 years old and up.
But doctors may prescribe other DMTs off label.
Off-label drug use
An off-label drug is when a medication approved by the FDA for one purpose is used for a different purpose that hasn’t been approved. But a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs but not how doctors use the drugs to treat people. So, a doctor can prescribe a drug however they think is best for your care. Learn more about off-label drug use.
While many relapses may go away on their own, more severe relapses can require treatment.
MS relapses are caused by inflammation within the CNS, and they’re typically treated with corticosteroids. These drugs can lower inflammation and help make MS attacks less severe. Corticosteroids used to treat MS include:
- dexamethasone (Dexamethasone Intensol)
- methylprednisolone (Medrol)
- prednisone (Prednisone Intensol, Rayos)
If corticosteroids don’t work, a doctor may prescribe corticotropin (H.P. Acthar Gel).
Corticotropin is an injection, and it’s also known as adrenocorticotropic hormone gel. It works by prompting your adrenal cortex to secrete the hormones cortisol, corticosterone, and aldosterone. The secretion of these hormones helps to lower inflammation.
Other drugs can be used to treat specific MS symptoms or complications from MS-related damage.
For walking problems
Dalfampridine (Ampyra) is an oral tablet taken twice per day to help improve your walking.
Dalfampridine works by blocking potassium channels, which form tiny pores in your nerve cells. This action may help your damaged nerve cells to better send messages.
Improved nerve impulse conduction aids in your leg muscle control and strength.
For muscle stiffness or spasms
A doctor will often give muscle relaxants to people with MS who have painful muscle stiffness or muscle spasms. Drugs commonly used to treat these symptoms include:
- baclofen (Lioresal)
- cyclobenzaprine (Amrix)
- dantrolene (Dantrium)
- diazepam (Valium)
- onabotulinumtoxinA (Botox)
- tizanidine (Zanaflex)
Ongoing fatigue is a common problem for people with MS. For this symptom, a doctor may prescribe a drug such as modafinil (Provigil).
They may also prescribe an off-label drug, such as amantadine (Gocovri) and fluoxetine (Prozac). Doctors may also prescribe amphetamines off label to treat fatigue.
Dysesthesia means “bad sensation.” It’s a type of pain that can feel like ongoing burning or itching. It may also feel like wetness, an electric shock, or pins and needles.
To treat dysesthesia, a doctor may prescribe:
- clonazepam (Klonopin)
- gabapentin (Neurontin)
- nortriptyline (Pamelor)
- phenytoin (Dilantin)
Drugs used to treat depression in people with MS include:
- bupropion (Wellbutrin SR, Wellbutrin XL)
- duloxetine (Cymbalta)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- venlafaxine (Effexor)
Constipation is another common complication of MS. A doctor may recommend treating it with one of the following over-the-counter drugs:
- bisacodyl (Dulcolax)
- docusate (Colace)
- magnesium hydroxide (Phillips’ Milk of Magnesia)
- psyllium (Metamucil)
For bladder dysfunction
Bladder dysfunction is also a common complication of MS. Symptoms may include frequent urination, incontinence, or hesitancy in starting urination. You may also experience frequent nocturia (nighttime urination).
Drugs to treat these symptoms include:
- darifenacin (Enablex)
- oxybutynin (Ditropan XL)
- prazosin (Minipress)
- solifenacin (VESIcare)
- tamsulosin (Flomax)
- tolterodine (Detrol)
For sexual dysfunction
Both men and women with MS tend to have higher rates of sexual dysfunction than the general population, according to an
Oral medications that may be prescribed to help treat erectile dysfunction include:
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra)
- avanafil (Stendra)
Older drugs that must be injected directly into the penis are also available. These drugs aren’t used as much now that oral drugs are available.
They include alprostadil (Caverject). A drug that may be used off label for this purpose is the blood pressure medication papaverine.
People with a vagina or clitoris may experience problems such as reduced feeling or vaginal dryness.
There are no drugs currently available to treat these problems. But for vaginal dryness, you can use water-soluble personal lubricants that are available over the counter.
Many different types of drugs are available to help you manage MS. The type of drugs that may be best for you depend on the type of MS you have and the symptoms you experience.
You may not be able to access all of these medications. Ask a doctor to confirm which drugs are currently on the market in your area and which ones might be most appropriate for you. Speaking with a doctor is especially important if you’re pregnant or planning to become pregnant.
Work with a doctor to create a plan to manage your MS symptoms and help prevent further damage from the disease. Sticking to your treatment plan can help you feel better and slow the progression of your condition.
It’s best to stay in contact with a doctor while taking medication for MS.
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