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 while causing 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 to keep you active for longer. 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 flares include:
- interferon beta 1b (Betaseron, Extavia)
- glatiramer acetate (Copaxone)
Disease-modifying drugs that have been shown to reduce flares and slow progression of MS include:
- interferon beta 1a (Avonex, Rebif)
- fingolimod (Gilenya)
- mitoxantrone (Novantrone)
- natalizumab (Tysabri)
Both 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.
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 a rare, but very serious viral infection of the brain, called progressive multifocal leukoencephalopathy (PML). If you do take this drug, you will be monitored very carefully while on it. 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.
Another possibility your doctor might suggest is the first MS drug that you can take by mouth, called fingolimod (Gilenya). Before you can take this drug, you'll need to have a chickenpox vaccine if you haven't already had chickenpox. That’s because during a clinical study one person died from chickenpox while taking Gilenya. Your doctor will also need to keep an eye on you for six hours the first time you take it because Gilenya can sometimes cause a drop in heart rate after the first dose.
In the most severe cases of MS that aren't responding to medication, doctors may prescribe mitoxantrone (Novantrone). This chemotherapy drug, which was originally designed to treat cancer, suppresses the immune system to prevent it from attacking nerve coverings. Novantrone is used sparingly, though, because it carries a “black box” warning -- the FDA’s most serious warning -- because of risks of heart damage and a type of leukemia.
