Medicines for multiple sclerosis (MS) may be used:
- During a relapse, to make the attack shorter and less severe.
- Over a long period of time, to alter the natural course of the disease (disease-modifying drugs or DMDs).
- To control specific symptoms as they occur.
Controlling a relapse
These medicines can shorten a sudden relapse and help you feel better sooner. They have not been shown to affect the long-term course of the disease or to prevent disability.
- Corticosteroids (such as methylprednisolone)
- ACTH (adrenocorticotropic hormone)
- Intravenous immunoglobulin (IVIG)
- Plasma exchange
Strong evidence suggests that MS is caused by the immune system causing inflammation and attacking nerve cells and myelin, which is the protective coating surrounding the nerve fibers. Medicines that change the way the immune system works can reduce the number and severity of attacks that damage the nerves and myelin.
For people who have relapsing-remitting MS, disease-modifying therapy can reduce the number and severity of relapses. It may also delay disability in some people. Some of these medicines may also delay disease progression and reduce relapses in some people who have secondary progressive MS.
The most commonly used disease-modifying therapies are:
- Interferon beta (such as Betaseron), for clinically isolated syndrome (first MS attack), relapsing-remitting MS, and secondary progressive MS.
- Glatiramer (Copaxone), for clinically isolated syndrome and relapsing-remitting MS.
Other disease-modifying medicines may also be used for MS. Your doctor will prescribe a medicine depending on the type of MS you have, your symptoms, and how your body responds. They include:
- Alemtuzumab (Campath).
- Dimethyl fumarate (Tecfidera).
- Fingolimod (Gilenya).
- Mitoxantrone (Novantrone).
- Natalizumab (Tysabri).
- Teriflunomide (Aubagio).
There is no effective disease-modifying treatment for primary progressive MS.
Some people have only one episode of a neurological symptom such as optic neuritis. Yet MRI or other tests suggest that these people have MS. This is known as a clinically isolated syndrome. Many of these people go on to develop MS over time. In most cases, doctors will prescribe medicine for people who have had a clinically isolated syndrome. These medicines, when taken early or even before you have been diagnosed with MS, may keep the disease from getting worse or extend your time without disease.3
Treating specific symptoms can be effective, even if it doesn't stop the progression of the disease. Symptoms that can often be controlled or relieved with medicine include:
- Muscle stiffness (spasticity).
- Urinary problems.
- Pain and abnormal sensations.
Medicines can also help with sexual problems, emotional problems, and walking problems. Sildenafil (Viagra) can help with sexual problems in both men and women. Clomipramine may also be given to improve erectile dysfunction. Dextromethorphan and quinidine (Nuedexta) is a medicine that can be used for uncontrollable outbursts of crying or laughing at strange or inappropriate times. Dalfampridine (Ampyra) is a medicine that can be used to help with walking problems.
Medicine may be used only some of the time or regularly, depending on how severe or constant a certain symptom is. Changes in diet, schedule, exercise, and other habits can also help manage some of these symptoms. See Home Treatment.
Cannabinoids are substances found in marijuana. Similar drugs can be created in a lab. Some forms of natural and man-made cannabinoids may help with symptoms such as pain and spasticity. They are not available in all areas. Talk to your doctor if you are considering cannabinoids.
Medicines being studied
A variety of other medicines and biological chemicals have been tried or are being studied as therapy for MS. None of them have been clearly proved as beneficial, and none have been approved for treatment of MS.
Several medicines are being tested in clinical trials. People with MS who have not responded to standard therapy sometimes choose to take part in these trials. To learn more about clinical trials, talk to your doctor or contact the National Multiple Sclerosis Society at www.nationalmssociety.org.
Deciding about disease-modifying therapy
The National Multiple Sclerosis Society recommends that people with a definite diagnosis of MS and active, relapsing disease start treatment with interferon beta or glatiramer. Most neurologists support this recommendation and now agree that permanent damage to the nervous system may occur early on, even while symptoms are still quite mild. Early treatment may help prevent or delay some of this damage. In general, treatment is recommended until it no longer provides a clear benefit.
The National MS Society also says that treatment with medicine may be considered after the first attack in some people who are at a high risk for MS (before MS is definitely diagnosed).
Despite the recommendation, some people find it hard to decide whether to begin disease-modifying therapy, especially when their symptoms have been fairly mild. Some may not want to bear the risks and side effects of medicine when they are not sure they need it. Some may want to see whether their disease gets worse before they start therapy. A small percentage of people diagnosed with MS may never have more than a few mild episodes and may never develop any disability, but the disease is unpredictable.
Insurance may not cover all types of treatment.
Treating symptoms and relapses
The need and desire for medicine vary. If your symptoms are mild, you may choose to manage them without any medicine. If you have specific symptoms that are causing problems, certain medicines may help you keep them under control. Or you may want to use medicine only during a relapse.
You may also want to think about:
- The possible side effects of using steroids or other medicines to treat symptoms or control a relapse. Some people have only minor side effects. But others may have side effects that concern them more than their MS symptoms.
- The costs of treating symptoms and controlling relapses. In some cases, using medicine to control symptoms and relapses may reduce the need for hospital stays.
- Other personal issues that you face at work or at home.
Also keep in mind that it can be hard to tell if medicine is helping. Multiple sclerosis is a disease with spontaneous remissions. This means that your condition can improve on its own, without any treatment. Just because your symptoms improve after treatment doesn't mean that a treatment is working.