What are the treatment options for multiple sclerosis?
Although there is no cure for MS, treatment can speed your recovery from relapses, manage symptoms, and slow the disease’s progression. Treatment is based on the duration and severity of your disease, if previous MS treatment was effective, and your overall health.
Early and aggressive treatment is very important because MS can damage the nervous system before you have symptoms. MS medications can reduce inflammation, nerve damage, loss of brain tissue, and long-term disability. Early treatment can also lower the relapse rate, slow the formation of new lesions, and potentially reduce risk of disability and brain atrophy.
To treat MS relapses these medications can be used:
- Corticosteroids reduce nerve inflammation. Side effects include insomnia, increased blood pressure, increased glucose levels, mood swings, and fluid retention.
- Plasmapheresis (plasma exchange) removes the liquid part of your blood from the blood cells. Blood cells are mixed with a protein solution and put back into your body. This treatment is used if the symptoms are new, or are severe and haven’t been helped with corticosteroids.
To slow or stop PPMS disease progression, ocrelizumab (Ocrevus) is the only medication with U.S. Food and Drug Administration (FDA) approval. It can slightly reduce the progression of MS.
To treat MS, several therapies are available in injectable, oral, or infusion form, including:
- Interferon beta medications are the most commonly prescribed and can reduce the frequency and severity of relapses. It is injected under the skin or into a muscle. Side effects can include flu-like symptoms and injection-site reactions. Blood tests are needed to monitor your liver for damage. Interferons can develop neutralizing antibodies that reduce drug effectiveness.
- Glatiramer acetate (Copaxone, Glatopa) is injected under the skin, and helps block the immune system from attacking the myelin sheath. Can cause skin irritation at the injection site.
- Fingolimod (Gilenya) is an oral medication that reduces the relapse rate. Side effects include a slowed heartbeat, infection, headaches, high blood pressure and blurry vision.
- Dimethyl fumarate (Tecfidera) is taken orally to reduce relapses. Side effects may include flushing, diarrhea, nausea, and lowered white blood cell count that requires regular blood monitoring.
- Diroximel fumarate (Vumerity) is taken orally to treat relapsing MS; causes fewer side effects.
- Teriflunomide (Aubagio) is taken orally to reduce relapse rate. It can cause liver damage, hair loss, and birth defects. It requires regular blood monitoring.
- Siponimod (Mayzent) is an oral medication that reduces relapse rate and slows progression of MPMS. Side effects may include viral infections, liver problems, low white blood cell count, changes in heart rate, headaches, vision problems, and can harm a fetus. Regular blood monitoring is required.
- Cladribine (Mavenclad) is an oral medication for RRMS and SPMS. Side effects may include respiratory infections, headaches, tumors, serious infections, and low white blood cell level that requires regular blood monitoring.
- Ocrelizumab (Ocrevus) is an intravenous infusion that treats RRMS and PPMS by reducing the relapse rate and slowing disability progression. Side effects may include irritation at the injection site, low blood pressure, fever, nausea, and an increased risk of infections and breast cancer.
- Natalizumab (Tysabri) is an infusion that blocks immune cells from entering the blood that goes to your brain and spinal cord. It’s a first-line treatment for patients with severe MS, or a second-line treatment for others. It increases the risk of a potentially serious viral infection of the brain.
- Alemtuzumab (Campath, Lemtrada) is an infusion that reduces MS relapses, and can limit nerve damage. It’s usually recommended for patients with aggressive MS or as second-line treatment for patients who aren’t helped by other medications. It can increase the risk of infections and autoimmune disorders.
Treatments to help manage symptoms include:
- Physical therapy (PT) can strengthen and stretch muscles and ease other symptoms. Therapists also teach how to use assistive devices and mobility aids to help manage leg weakness and gait problems.
- Muscle relaxants are needed for painful or uncontrollable muscle stiffness or spasms (baclofen, tizanidine, and cyclobenzaprine).
- Fatigue can be reduced with amantadine, modafinil, and methylphenidate; selective serotonin reuptake inhibitors may be added.
- Increase walking speed - dalfampridine slightly increases walking speed.
- Other symptoms may be treated with medications for depression, pain, insomnia, bladder and bowel control, or sexual dysfunction.