Treatments for Multiple Sclerosis

There's no cure for multiple sclerosis (MS), but medicines can help you manage the disease. Work closely with your doctor to find the treatment that's best for you and causes the fewest side effects.

Disease-Modifying Drugs

If you have a type of multiple sclerosis called relapsing-remitting MS and your condition is acting up, your doctor may first treat you with a disease-modifying drug. These medicines slow down the advance of your disease and prevent flare-ups.

The drugs work by curbing the immune system -- your body's main defense against germs -- so that it doesn't attack the protective coating called myelin that surrounds the nerves.

Disease-modifying drugs that can reduce the number of flare-ups include:

  • Glatiramer acetate (Copaxone, Glatopa)
  • Interferon beta-1b (Betaseron, Extavia)

Medicines that both cut down the number of flare-ups and slow the advance of MS include:

  • Daclizumab (Zinbryta)
  • Dimethyl fumarate (Tecfidera)
  • Fingolimod (Gilenya)
  • Interferon beta-1a (Avonex, Rebif)
  • Mitoxantrone (Novantrone)
  • Natalizumab (Tysabri)
  • Ocrelizumab (Ocrevus)
  • Peginterferon beta-1a (Plegridy)
  • Teriflunomide (Aubagio)

The interferon drugs and Copaxone are considered very safe. Most of the side effects are due to the injection itself, such as redness, warmth, itching, or dimpling of the skin where your doctor injected the drug.

With interferon drugs, it's common to have flu-like symptoms, such as aches, fatigue, fever, and chills, but these should fade within a few months. The medications can also slightly raise your risk for infections by lowering the number of your white blood cells that help the immune system fight illnesses.

Three drugs that you take by mouth treat the relapsing form of MS. Teriflunomide (Aubagio) is a tablet you take once a day. The most common side effects include diarrhea, abnormal liver tests, nausea, and hair loss. But Aubagio does carry a "black box" warning, the FDA's most serious warning, because of liver problems and birth defects. If you take this medicine, your doctor will likely do regular tests to check how well your liver is working. And you shouldn't take this drug if you're pregnant.

Gilenya is another once-a-day tablet for relapsing MS. Before you can take this drug, you'll need to get a vaccine for chickenpox if you haven't already had chickenpox. That's because during a clinical study one person died from chickenpox while taking Gilenya.

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Gilenya's most common side effects include headache, diarrhea, back pain, cough, and abnormal liver tests. Because the medicine may cause a slow heart rate, your doctor will watch you closely after your first dose. Also, some possible cases of progressive multifocal leukoencephalopathy (PML) -- a rare brain infection -- have been reported in people taking this drug.

Tecfidera is a tablet you take twice a day for relapsing MS. It may cause low levels of immune cells, so your doctor will do regular blood tests to check for that. The drug's most common side effects are flushing, stomach pain, diarrhea, nausea, and vomiting. An active ingredient similar to the one in Tecfidera has been linked to four cases of PML.

If these drugs don't work for you, the next step might be to try a different disease-modifying medication called natalizumab (Tysabri). It prevents immune cells from getting to your brain and spinal cord, where they can damage nerves. The drug has been linked to PML, so your doctor may suggest it only if other medications fail. If you do take it, your doctor will keep an eye on you carefully. A blood test can help doctors check risk for PML.

In the most severe cases of MS that don't respond to medication, doctors may prescribe mitoxantrone (Novantrone) or alemtuzumab (Lemtrada). Both are chemotherapy drugs designed to treat cancer. They are used to treat certain types of MS by curbing the immune system to prevent it from attacking nerve coverings. Novantrone is used sparingly, though, because it has an FDA "black box" warning because of risks of heart damage and a type of leukemia.

Treating Flare-Ups

Your MS medications are designed to prevent flare-ups, but you can still get some that sometimes can interfere with your ability to get around. Mild flare-ups will eventually go away on their own, so if they're not bothering you, you don't need to treat them. On the other hand, if a flare-up gets in the way of your life, your doctor may give you high-dose steroids through a vein (intravenously) or by mouth to make the relapse go away more quickly. Steroids won't slow down the course of your overall disease, though.

In a small percentage of people with severe relapses that don't respond to steroids, doctors might recommend a technique called plasma exchange. During this procedure, a doctor removes blood from you and separates the liquid portion (called plasma) from the white and red blood cells. The plasma gets replaced before the blood is put back into your body.

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Other Ways to Manage Your Symptoms

To target specific symptoms of MS, your doctor may recommend these medications:

Muscle stiffness and spasms: Muscle relaxants such as baclofen (Lioresal) and tizanidine (Zanaflex), or sedatives like clonazepam (Klonopin) and diazepam (Valium)

Fatigue: Amantadine (Symmetrel), armodafinil (Nuvigil), modafinil (Provogil)

Depression: Antidepressants, such as bupropion (Wellbutrin), fluoxetine (Prozac), and sertraline (Zoloft)

Bladder problems: Oxybutynin (Ditropan) or tolterodine (Detrol)

A physical therapist can teach you how to do exercises that help keep you more active. Also, a cane, walker, or other assistive devices can make it easier to get around.

It's important to start medication for your MS as early as possible and to continue taking it over the long term so that it can prevent further damage and slow the advance of the disease.

Since you may need to take MS drugs for a long time, you should make sure you're comfortable with them. If your side effects become hard to handle or the medication doesn't help, talk to your doctor. You may need to switch to a different medicine.

WebMD Medical Reference Reviewed by William Blahd, MD on April 19, 2017

Sources

National Multiple Sclerosis Society: "Disease Management Consensus Statement," "Fingolimod," "Novantrone (mitoxantrone),"  "Exacerbations,"  "FDA Approves Plegridy (Pegylated Interferon Beta) For Relapsing MS."

John Ratchford, MD, assistant professor of neurology, Johns Hopkins School of Medicine.

NINDS: "Multiple Sclerosis Information Page."

Goldman, L. Cecil Medicine, Saunders Elsevier, 2007.

FDA: "Safety Update on Progressive Multifocal Leukoencephalopathy (PML) Associated with Tysabri," "FDA approves new multiple sclerosis treatment Aubagio," "FDA investigating rare brain infection in patient taking Gilenya (fingolimod)."

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