Now that you finally have a name -- multiple sclerosis -- to match the symptoms that have been plaguing you, you've probably got a lot of questions about how to treat those symptoms and keep your condition from getting worse. Although researchers haven't yet discovered a cure for MS, there are many effective medications to help manage your disease. Your doctor will work closely with you to find the treatment that works best for you and causes the fewest side effects.
Here is a rundown of your MS treatment options.
Changing the Course of Your MS: The Disease-Modifying Drugs
If you have active relapsing-remitting MS, your doctor will first treat you with one of the disease-modifying drugs. They're called disease-modifying drugs because they can actually slow down the progression of MS and prevent relapses. These drugs work by suppressing the immune system so that it doesn't attack the protective coating (myelin) surrounding the nerves.
Disease-modifying drugs that reduce the number of exacerbations include:
Disease-modifying drugs that have been shown to reduce exacerbations and slow the progression of MS include:
- interferon beta-1a (Avonex, Rebif)
- peginterferon beta-1a (Plegridy)
- teriflunomide (Aubagio)
- fingolimod (Gilenya)
- mitoxantrone (Novantrone)
- dimethyl fumarate (Tecfidera)
- natalizumab (Tysabri)
- daclizumab (Zinbryta)
The interferon drugs and Copaxone are considered to be very safe. Most of the side effects that do occur stem from the injection itself, including redness, warmth, itching, or dimpling of the skin over the injection site. With the interferon drugs, it's common to have flu-like symptoms -- aches, fatigue, fever, and chills -- but these should fade within a few months. The interferon drugs can also slightly increase your risk for real infections by lowering the number of white blood cells that help your immune system fight off illnesses.
There are three oral drugs available to treat the relapsing form of MS. Aubagio is a once-a-day tablet. The most common side effects of Aubagio include diarrhea, abnormal liver tests, nausea, and hair loss. However, Aubagio does carry a “black box” warning -- the FDA’s most serious warning -- because of liver problems and birth defects. Doctors should periodically do liver function testing in those on the drug. The medication should not be taken by pregnant women.
Gilenya is another once-daily tablet for relapsing MS. Before you can take this drug, you'll need to have 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. Gilenya's most common side effects include headache, diarrhea, back pain, cough, and abnormal liver tests. Because Gilenya may cause a slow heart rate, your doctor will watch you closely after your first dose. PML has recently been reported with this drug.
Tecfidera is a twice-daily tablet for relapsing MS. It may cause low levels of immune cells, so your doctor will do regular blood tests to check for that. An active ingredient similar to the one in Tecfidera has been linked to four cases of a serious brain infection called progressive multifocal leukoencephalopathy (PML). The drug's most common side effects are flushing, stomach pain, diarrhea, nausea, and vomiting.
If these drugs don't work for you, the next step might be to try a different disease-modifying medication called natalizumab (Tysabri). Tysabri prevents immune cells from getting to your brain and spinal cord, where they can damage nerves. This drug is used only if other medications fail, because it has been linked to PML. If you do take this drug, you will be monitored very carefully. According to the FDA, PML incidence per 1,000 patients is 0.3 cases during the first two months of treatment, 1.5 cases during 25 to 36 months of treatment, and 0.9 during 37 to 48 months of treatment. A blood test can help doctors assess risk for PML. The test looks for evidence of exposure to the JC virus, which causes PML.
In the most severe cases of MS that aren't responding 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 suppressing the immune system to prevent it from attacking nerve coverings. Novantrone is used sparingly, though, because it carries a FDA “black box” warning of risks of heart damage and a type of leukemia.
Your MS medications are designed to prevent flare-ups, but you can still get exacerbations that sometimes can seriously interfere with your ability to get around. Mild exacerbations 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 is getting in the way of your life, your doctor may give you high-dose steroids through a vein (intravenously) or by mouth to bring the flare-up to a speedier end. Steroids won't slow down the course of your overall disease, though.
In a small percentage of people with very severe relapses that don't respond to steroids, doctors might recommend a technique called plasma exchange. During this procedure, your blood is removed and the liquid portion (plasma) is separated out from the white and red blood cells. The plasma is replaced before the blood is put back into your body.
Other Ways to Cope
- Muscle stiffness and spasms: muscle relaxants such as tizanidine (Zanaflex) and baclofen (Lioresal), or sedatives like diazepam (Valium) and clonazepam (Klonopin).
- Fatigue: amantadine (Symmetrel), modafinil (Provogil), armodafinil (Nuvigil), and methylphenidate (Ritalin)
- Depression: antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), and bupropion (Wellbutrin)
- Bladder problems: oxybutynin (Ditropan) or tolterodine (Detrol)
Working with a physical therapist can teach you how to do exercises that will help keep you more active. If you have lost some physical ability, a cane, walker, or other assistive devices can make it easier to get around.
It's vital 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 progression of the disease. Because you will be on the MS drugs indefinitely, it's important for you to be comfortable with them. If your side effects are intolerable or the medication isn't helping, talk to your doctor. You may need to switch to a different drug.