MS medications: Knowing the options

MS is an autoimmune disease of the central nervous system, which comprises the brain and spinal cord.

It’s a chronic condition that could damage the brain and spinal cord’s nerve cells. The damage can worsen over time, but with the right care, the condition is manageable.

What are disease-modifying treatments?

If you have MS, you may exhibit symptoms like limb weakness, difficulty walking, unusual sensations, and visual disturbances.

Early diagnosis and therapy may help reduce any worsening nerve cell damage.

Disease-modifying therapies, also known as disease-modifying drugs (DMDs), are classes of drugs doctors typically use to reduce relapse frequency or slow disease progression in recurrent MS cases.

These drugs partially deplete your immune system (known as having immunosuppressive effects) and help to control the inflammation that injures cells.

Examples of these drugs include: 

• glatiramer acetate (Copaxone) 
• dimethyl fumarate (Tecfidera) 
• fingolimod (Gilenya)
• interferon beta preparations, like Plegridy
• natalizumab (Tysabri)
• mitoxantrone

Treating MS types 

Generally, doctors consider the type of MS when deciding which drugs to include in a treatment plan. The type of MS you have is determined by its location, duration, and extent of nerve cell damage. 

 MS has the following types:

• Relapsing-remitting MS (RRMS): These are cases that recur often and account for approximately 60% of overall cases.
• Primary progressive MS (PPMS): Here, symptoms progress from the start.
• Secondary progressive MS (SPMS): This describes symptoms that progress from RRMS.
• Clinically isolated syndrome (CIS): Symptoms of CIS suggest multiple sclerosis but don’t fulfill the full diagnostic criteria.

MS drugs

MS drugs work by controlling the immune system’s response to inflammatory chemicals. This helps to lower the inflammation’s intensity in the central nervous system. 

Scientists suggest inflammation is one of the causes of nerve cell damage and loss of neurons in MS.

RRMS drugs

Some of the drugs offered for RRMS include:

• Interferon beta preparations: Interferon beta injections are first-line medications for MS. Doctors or healthcare professionals typically inject interferon beta drugs under the skin or into a muscle. Side effects may include flu-like symptoms or injection site reactions.
• Glatiramer acetate (Copaxone): Glatiramer acetate is an injection that doctors or nurses administer under the skin. Common side effects of Glatiramer acetate are:
  • injection site reactions 
  • chest pain
  • heart palpitations
  • anxiety
  • breathing difficulties (dyspnea)
  • unusually fast heartbeat (tachycardia)
  • skin rashes (urticaria)
• Dimethyl fumarate (Tecfidera): This is an oral drug your doctor may prescribe for RRMS. Side effects include stomach or gastrointestinal symptoms and skin flushing.
• Fingolimod (Gilenya): Fingolimod is an oral drug for treating MS. Side effects may include:
  • fatigue
  • unusually slow heart rate (bradycardia)
  • liver damage
  • a condition called lymphocytopenia, which involves reduced white blood cells that look after your immune system (lymphocytes)
• natalizumab (Tysabri): Natalizumab is an intravenous (IV) infusion medication for RRMS. Side effects may include mild headache and skin flushing at the injection site.
• teriflunomide (Aubagio): This is a once-daily, oral drug typically prescribed for RRMS. Side effects can include hair thinning or loss, headaches, nausea, and joint pain.
• mitoxantrone: Mitoxantrone is also an IV drug, and the possible side effects are:
  • nausea or vomiting 
  • loss of periods (amenorrhea)
  • infertility 
  • hair loss
  • blue discoloration of the eyes and urine

A more recent addition is siponimod (Mayzent) which received approval from the Food and Drug Administration (FDA) in 2019.

Corticosteroids

Doctors typically use short-course corticosteroid therapy for some cases of RRMS.

Corticosteroids may come as a tablet or injection. The following are examples of corticosteroids:

• dexamethasone (Decadron)
• methylprednisolone acetate (Depo-medrol)
• methylprednisolone (Medrol)
• prednisolone anhydrous
• prednisolone Odt (Orapred Odt, Pediapred)
• prednisolone (Millipred and Millipred Dp)
• triamcinolone diacetate (Aristocort)
• prednisolone sodium phosphate

Side effects of corticosteroids include:

• increased blood sugar
• muscle tissue disease (myopathy) 
• glaucoma and cataracts
• psychiatric changes 
• a reduced immune system (immunosuppression) 
• cardiovascular disease

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PPMS

Doctors may choose to use immunosuppressant drugs such as azathioprine and cyclophosphamide for PPMS.

They may also choose ocrelizumab (Ocrevus), which is another treatment for PPMS that doctors can prescribe without attempting prior therapies.

SPMS

Some drugs for RRMS can also effectively treat SPMS. Examples include:

• interferon beta injections
• mitoxantrone
• siponimod (Mayzent)

CIS

Drugs like glatiramer acetate and interferon beta injections may also effectively treat CIS.

Therapeutic options for MS

In addition to DMDs, doctors may recommend other drugs to help manage MS symptoms like:

• muscle spasms
• bladder weakness
• walking difficulties
• pain
• depression
• bowel dysfunction

Your doctor will assess your symptoms and decide on the best medications.

Summary

MS is a chronic autoimmune disease characterized by inflammatory damage to the nerve cells in the central nervous system. It’s a progressive disorder that sees nerve cell damage in the brain and spinal cord.

Doctors often choose DMDs or therapies for reducing episode frequency or progression. These drugs slow the response of your immune system and help to control the inflammation responsible for nerve cell damage.

MS symptoms vary but may include limb weakness, difficulty walking, unusual sensations, visual disturbances, and organ dysfunctions. Early diagnosis and prompt therapy may help reduce the nerve cell damage of MS.

Talk with your doctor if you feel you have symptoms that could be MS, as they can run tests to help confirm or rule out the condition.

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