Changing the Course of Your MS: The Disease-Modifying Drugs continued...
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 PML. However, this has not been seen in patients taking Tecfidera. The four patients also had additional risk factors for PML. Tecfidera'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 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.
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 FDA “black box” warning because 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 and sometimes they 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) 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), and armodafinil ( Nuvigil)
- 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 braces 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 your disease from getting worse. 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.