Multiple sclerosis (MS) is an autoimmune disease that attacks the central nervous system of primarily young adults. The progressive and relapsing nature can be debilitative and lead to paralysis. MS does not have a cure, but a variety of medications may help slow the progression, reduce relapses, and manage complications.
Medications for treatment of MS
There is no cure for MS, and relapses or exacerbations are common. As a result, treatment approaches, including medications, delay progression, reduce inflammation, and manage complications.
Many FDA-approved medications serve to reduce the number of relapses, delay disability progression, and hinder new disease activity.
The National Multiple Sclerosis Society has an extensive list of disease-modifying drugs for managing multiple sclerosis that can be administered orally, by injection, or infused. The oral medications are all synthetic (chemical), while the infused medications are biological (natural). The injected drugs may be either synthetic or biological.
Examples of injectable medication include Avonex, Betaseron, Extavia, Rebif, and they belong to a class of medications known as interferon beta. Interferon beta is usually the first-line treatment for MS.
Interferons are naturally occurring cell-signaling molecules that help regulate inflammatory responses. They also have the potential to increase neuron survival and repair. Clinical effects seen include fewer lesions of damage seen in MRI and reduced risk of disability progression.
Considerations regarding interferon beta
- Administration. The main difference between the types of interferon beta is the dosing frequency and type of injection, under the skin (subcutaneous) or in the muscle (intramuscular). Subcutaneous administration dosing could range from alternative days to once weekly.
- Side effects. Depending on route and dose, subcutaneous injections may have reactions such as redness, swelling, or tenderness at the injection site. Intramuscular injections can cause flu-like symptoms, body aches, and headaches; however, the body can adapt after regular use.
- Safety. Interferon beta was the first FDA-approved drug for MS and is most commonly used. According to research, it can reduce relapses by approximately 30% and reduce lesions of damaged neurons. The safety profile of interferon beta is relatively well established considering it has been on the market since 1993.
- Testing/monitoring. Generally, before commencing this treatment, a complete blood count (CBC) is performed along with liver function tests to check for liver issues or damage. This can also be checked periodically during treatment to detect liver damage as early as possible.
- Pregnancy (category C). The data about the use of interferon beta during pregnancy is insufficient. Animal studies have demonstrated adverse effects, but there is no clear indication of the risks, benefits, or effectiveness of interferon beta for pregnant individuals.
Oral administration has significant therapeutic advantages and increases patient compliance. Examples of drugs are fingolimod, teriflunomide, and dimethyl fumarate.
- Fingolimod (Tascenso ODT) was the first oral drug approved by the FDA for the treatment of multiple sclerosis. It has immunosuppressive effects and possibly neuroprotective or repair effects.
- Teriflunomide (Aubagio) is also an immunosuppressant drug. In a rat model study, this drug showed a delay in the onset of MS and reduced relapse frequency.
- Dimethyl fumarate (Fumaderm) gained FDA approval for the treatment of relapsing-remitting multiple sclerosis based on comprehensive studies evaluating its long-term effectiveness and safety profile. Its approval was supported by analyses showcasing its neuroprotective properties and anti-inflammatory actions, solidifying its role as a treatment option for MS.
Infusion therapy can be provided at an infusion facility. Common medication includes Tysabri, Ocrevus, and Lemtrada. Infusions can be prescribed to patients who have relapsing–remitting multiple sclerosis and if other forms of treatment have failed to provide relief.
Natalizumab (Tysabri) is FDA-approved and is known to limit the abnormal immune response in the brain and spinal cord. It proved to be effective by reducing relapse rates by 60%. However, it was briefly taken off the market due to a fatal side effect — Progressive Multifocal Leukoencephalopathy (PML) — which is an infection in the brain. To reduce the risk of this condition, it was granted that thorough monitoring would be required and all patients would be part of a program. Due to the drug's effectiveness and actions to reduce risk, it was later brought back on the market.
The course of infusion treatment differs according to the drug prescribed, with schedules for doses and duration of infusions subject to variation. Side effects would also depend on the medication; however, some general side effects of infusions are rashes, fatigue, fever, and a weakened immune system. After the infusion is complete, patients are usually observed for a while to check for adverse reactions.
Some drugs are used off-label. This means the drug’s use is for reasons other than what was studied and approved for. However, the off-label use has strong evidence of its effectiveness and safety in different conditions. For example, Rituximab is indicated for cancer treatment but is also effective in managing multiple sclerosis.
Essential medication list
The World Health Organization (WHO) publishes an Essential Medication List (EML) of evidence-based and cost-effective drugs that every healthcare organization should provide. WHO did not include any medications for MS treatment until 2023. Currently, cladribine, glatiramer acetate, and rituximab are on the EML.
Managing symptoms of MS
Symptoms of MS can vary from person to person. Depending on when and where the damage occurs in the brain, symptoms can include:
- Vision problems. Many people might notice this symptom first and may present as double vision, loss of color vision, and involuntary shaking of the eyes.
- Bladder problems. 80% of MS patients may suffer from this, issues can range from frequent nighttime urination to the inability to completely empty the bladder.
- Bowel dysfunction. Constipation or loss of control of the bowels. This can be managed through medication, diet, and adequate fluid intake.
- Depression or emotional changes. The stress of living with MS can be overwhelming, leading to mood swings, anxiety, and depression.
- Pain. Nerve pain, which is known as neuropathic pain, can feel like a burning, sharp, stabbing pain. It can be managed with medication or interventions.
- Sexual problems. Due to the damage to the nervous system, male patients commonly experience delay or inability to ejaculate, while female patients may experience low desire and sexual pain.
- Spasticity. A common symptom of MS that can be as mild as tense muscles or as severe as uncontrolled leg spasms. It could contribute to walking difficulties.
Multiple sclerosis can be difficult to deal with as it is an unpredictable and complex condition. It can impact every aspect of life, so it is crucial to seek the right care and support. Having an active and healthy lifestyle, wellness strategies, and stress management can support overall health in MS. In addition, with breakthroughs in research, MS diagnosis and treatment continue to develop and enhance patient outcomes.
What is multiple sclerosis?
Multiple sclerosis (MS) is a chronic condition characterized by the body's immune system erroneously targeting the central nervous system. Specifically, MS targets the nerve cells of the central nervous system, leading to inflammation and damage to the protective sheath surrounding these nerves.
In what age group is MS usually diagnosed?
Multiple sclerosis can occur in children and older adults, but most people are usually diagnosed between the ages of 20 and 50.
Can multiple sclerosis be cured?
Currently, there is no cure, and the main treatment focuses on managing the symptoms that affect individuals. Early treatment can minimize disability and slow down progression.
Multiple sclerosis is a progressive autoimmune disease that causes nerve damage to the brain, spine, and eyes.
Medications can help reduce inflammation, prolong relapses, and manage complications. However, there are no medications to cure multiple sclerosis yet.
Relapse prevention drugs may be administered orally, by injection, or by infusion.
Additional medications can help manage the many complications and symptoms of MS.
- NIH. What is the WHO essential medicines list?
- World Health Organization (WHO). WHO endorses landmark public health decisions on essential medicines for multiple sclerosis.
- National MS Society. Medications.
- National MS Society. What is MS?
- National Library of Medicine. Oral disease modifying treatments for multiple sclerosis.
- National Library of Medicine. The mechanism of action of interferon-β in relapsing multiple sclerosis.