Making MS Treatment Decisions
As recently as 1992, there were no drugs approved to treat multiple sclerosis. Today however, there are several drug treatments available for MS. "The future has never looked brighter for [people with] MS," says Aaron Miller, M.D., medical director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai Medical Center in New York City. And, he adds, "I anticipate that in the [near future], we'll have perhaps another four new multiple sclerosis drug treatments."
While some of the newer therapies can delay progression and modify the course of the disease, others can help with flare-ups and ease the symptoms of MS-related issues. This guide will help you understand the different options in multiple sclerosis treatment and their benefits.
Change the Course of Multiple Sclerosis
The initial treatment if you have relapsing MS may be one of the injectable disease-modifying drugs: interferon beta-1a (Avonex, Rebif) and -1b (Betaseron, Extavia>) or glatiramer acetate (Copaxone). The once-daily oral medication fingolimod (Gilenya) is also a first choice for many. In March 2013, the U.S. Food and Drug Administration (FDA) approved dimethyl fumarate (Tecfidera) capsules to treat relapsing MS in adults.
Plegridy (peginterferon beta-1a) was approved by the FDA in August 2014. This disease-modifying therapy is approved for adults with relapsing forms of MS. It is injected under the skin every 2 weeks to maintain the effects of interferon over a longer period of time and reduce MS symptoms and progression.
Side effects are similar to other interferon drugs and include reactions at the injection site, flu-like symptoms, weakness, and joint pain. In people receiving Plegridy, regular blood tests are performed to monitor liver function. The medication should not be administered during pregnancy. Talk to your health care provider about the benefits and risks of this treatment.
For people who respond poorly to the above treatments, intravenous (IV) therapies mitoxantrone (Novantrone) and natalizumab (Tysabri) are an option. The IV medications are powerful, but they can have significant side effects. Novantrone, for example, increases your risk of heart failure.
Essentially, these MS medications reduce inflammation in the central nervous system. This lessens the frequency and severity of flare-ups, the development of brain and spinal cord lesions and the appearance of new MS symptoms. The earlier you start, the more you can delay advancement.
These drugs may reduce relapse rates and prevent flare-ups by about 30 to 68 percent in addition to slowing disease progression, says Dr. Miller.
Relieve MS Symptoms
Symptom-management drugs can treat specific ailments associated with relapsing or progressive MS.
These treatments focus on particular symptoms, such as bladder problems, balance issues, muscle spasticity, fatigue and pain. For example, medications such as amantadine (Symmetrel) can help with fatigue.
Effectiveness varies; people often need to try several different medications and sometimes more than one may be required.
Ease MS Flare-Ups
If you have relapsing MS and a flare-up that lasts at least 24 hours—and occurs at least a month after a previous flare-up—a corticosteroid may help.
Methyl-prednisolone, prednisone and dexamethasone are steroids that are meant to mimic the hormone cortisol. High doses of oral or intravenous steroids for three to five days can reduce inflammation in the nervous system, which decreases the severity and duration of symptoms, speeding recovery.
Corticosteroids are highly effective for most people, but long-term use isn’t recommended, thanks to serious side effects that may include diabetes, weight gain and osteoporosis. For severe flare-ups that respond poorly to steroids, plasmapheresis, an outpatient procedure in which inflammatory substances are filtered out of the blood, may be an option.
Get Strong After MS Flares
If you’ve had a recent flare-up, physical, occupational and/or speech therapy can help you get back on track.
“These therapies help retrain your brain once you’ve had a flare-up,” says Susan Bennett, P.T., a clinical associate professor of rehabilitation science and neurology at the University at Buffalo in New York. “Once you regain the skills that have been lost, you need to maintain that improved function with regular exercise and repeated practice.”
Your physical therapy sessions might include gait and strength-training and stretching exercises to improve muscle flexibility. Occupational therapy can strengthen your vision, fine motor skills and cognitive function, improving your ability to participate in everyday activities, such as getting dressed.
Speech therapy can help you build weak facial and neck muscles and reduce speech and swallowing issues. A speech pathologist can also offer advice on how to change the consistency of food or the positioning of your head and neck to make swallowing easier.
Most people who undergo rehabilitation see benefits.