Once you switch over from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS), you may need to adjust your treatment plan.
The kind of SPMS you have will help your doctor figure out how to manage your disease. There are four types -- active, active-progressing, non-active progressing, and stable. Each one gets a different treatment style.
When you have active SPMS, it means that you still have relapses -- periods of time when your symptoms flare up -- just like when you had the relapsing-remitting form of the disease.
If that's the case, your doctor may suggest you take medications called disease-modifying drugs (DMDs), as you did when had RRMS. DMDs can help prevent relapses and make the ones you do get less severe.
DMDs that treat SPMS include:
- Alemtuzumab (Lemtrada)
- Cladribine (Leustatin, Mavenclad)
- Diroximel fumarate (Vumerity)
- Dimethyl fumarate (Tecfidera)
- Fingolimod (Gilenya)
- Glatiramer acetate (Copaxone)
- Interferon beta-1b (Avonex, Betaseron, Extavia, Plegridy, Rebif)
- Mitoxantrone (Novantrone)
- Monomethyl fumarate (Bafiertam)
- Natalizumab (Tysabri)
- Ocrelizumab (Ocrevus)
- Ofatumumab (Kesimpta)
- Ozanimod (Zeposia)
- Ponesimod (Ponvory)
- Sponimod (Leustatin, Mayzent)
- Teriflunomide (Aubagio)
You can continue to take the same drug you took when you had RRMS if it has helped you.
Corticosteroid drugs are another option. They bring down inflammation in your brain and spinal cord to make your relapses shorter and less severe.
You'll usually take steroid medicines for only short periods of time because they can cause side effects like:
- Upset stomach
- Fast heartbeat
- Flushing of the face
- Mood swings
- Chest pain
- Weak bones (when you use them for a long time)
In this type, you have relapses and your symptoms gradually get worse. You may need stronger treatment.
Your doctor can switch you to a different DMD. Or you can take the chemotherapy drug mitoxantrone (Novantrone). It works by stopping the attack by the immune system -- your body's defense from germs -- against myelin, the protective coating around your nerve cells.
Cladribine (Leustatin, Mavenclad), novantrone, and siponimod (Mayzent) are drugs that are FDA-approved specifically for treating SPMS. Novantrone is not used very often because it can cause side effects such as serious heart problems and an increased risk for infections and leukemia.
Non-Active Progressing SPMS
In this type of SPMS, you don't have relapses but your symptoms get worse. If that's your situation, you can try rehabilitation. This program uses several different types of therapy to improve your strength and ability to move.
A rehabilitation program can include:
Physical therapy. A physical therapist teaches you exercises to improve your strength, balance, energy level, and pain. If you have trouble walking, your therapist can show you how to get around with a cane, crutches, or a scooter.
Occupational therapy. This program teaches you how to manage your daily activities more easily. You'll learn how to:
- Conserve energy
- Use tools to help you get dressed, cook, and do other tasks
- Change your work area to make it easier to get things done
Cognitive rehabilitation. MS can affect your ability to think, concentrate, and remember. A therapist checks the problems you're having and then suggests ways to improve your memory, attention, and other thinking skills.
Speech-language therapy. MS can damage the muscles that control speech and swallowing. A speech-language therapist will teach you how to talk more clearly and easily, and eat without choking.
If your SPMS is stable and your symptoms aren't getting worse, your doctor will recommend treatments to help manage them and keep you moving. This may include rehabilitation and drugs to treat problems like:
- Trouble sleeping
- Frequent peeing
Choosing a Treatment
Discuss all of your treatment options with your doctor based on your type of SPMS. Ask how each therapy could help your symptoms and what side effects it might cause so you can make an informed choice.