At present there is no cure for MS, but management of the disease includes drug treatments to speed up the clinical improvement from relapses, medications that reduce the risk of further relapses (commonly known as disease modifying therapies), and therapies that alleviate and improve various symptoms. Successful management of MS also includes a healthy diet, exercise and rehabilitation.
The following information should not be relied on to suggest a course of treatment for a particular individual, and it should not be used in place of a visit, call, consultation or the advice of a physician or other qualified healthcare provider.
Treatment during a relapse
MS relapses are caused by inflammation in the central nervous system that damages the myelin coating around nerve fibres. This damage slows or disrupts the transmission of nerve impulses and causes the symptoms of MS.
Acute relapses are commonly treated with steroids, which can be given intravenously or orally for only a few days. The steroids work by shutting down the inflammation that is causing demyelination. Steroids are not believed to have any long-term benefit on the disease but they can be effective at speeding up recovery from relapse.
Disease modifying treatments are not a cure for MS but aim to prevent or reduce the number of relapses that occur in relapsing-remitting MS. Whether any of these drugs slow down the rate of disability in the long term is not yet clear and is a current focus of research.
Drugs commonly used to modify the disease course in MS
- beta interferon-1a (Avonex): injected into a muscle once a week.
- beta interferon-1a (Rebif): injected under the skin three times a week.
- beta interferon-1b (Betaferon): injected under the skin every other day.
- beta interferon-1b (Extavia): injected under the skin every other day.
- glatiramer acetate (Copaxone or Brabio): injected under the skin daily, or three times a week at a higher dose.
- glatiramer acetate (generic): injected under the skin daily.
- peginterferon beta 1a (Plegridy): injected under the skin once every two weeks.
- cladribine (Mavenclad): pills taken for up to five consecutive days in the first month and for up to five consecutive days in the second month, course repeated a year later. This may need to be repeated at some point in the future.
- dimethyl fumarate (Tecfidera): taken as a capsule, twice daily (also called BG12).
- fingolimod (Gilenya): taken as a capsule, once daily. The first dose is taken under medical supervision to monitor heart rate and blood pressure.
- teriflunomide (Aubagio): taken as a tablet, once daily.
- alemtuzumab (Lemtrada): taken as two treatment courses of intravenous infusions. The first course consists of intravenous infusions on five consecutive days. The second course is taken 12 months later and consists of intravenous infusions on three consecutive days. Some people may need a third or further infusion.
- natalizumab (Tysabri): taken as an intravenous (IV) infusion via a drip once every four weeks. It is generally administered in a hospital infusion clinic by a qualified health professional.
Other drugs that have been used to modify the disease course in MS
In some countries, a number of other immune suppressing or modifying treatments are still used to treat relapsing multiple sclerosis, although in many countries these have been replaced by the treatments above.
They can be useful for some people with MS, for example for those with more severe or frequent relapses or for people whose MS is rapidly worsening. Neurologists and people with MS need to work together to balance the positive effects of the drugs against their potential adverse side effects. These include:
- azathioprine (Imuran)
- cyclophosphamide (Endoxana)
- intravenous immunoglobulin (IVIg)
- methotrexate (Maxtrex)
- mitoxantrone (Novantrone)
The drugs listed above have generally not been found to be useful for people with progressive MS, although of course many people with MS will have an evolving condition where they have secondary progressive MS, but still have inflammatory relapses.
The notable exception is ocrelizumab, a new treatment option for MS, which works by targeting a type of immune cell, called a B cell. This helps to reduce the immune response by stopping these cells from attacking and damaging myelin.
In April 2017, ocrelizumab was approved as a treatment for both relapsing and primary progressive MS in the US. It is the first licensed treatment for people with primary progressive MS. The decision was made by the US Food and Drug Administration (FDA). In its latest trial results, researchers found that ocrelizumab reduced relapses, MRI activity and slowed progression in relapsing MS. It was also found to slow progression in primary progressive MS.
In January 2018, the European Medicines Agency (EMA) approved ocrelizumab (Ocrevus) for the treatment of adults with relapsing multiple sclerosis (RMS) and early primary progressive multiple sclerosis (PPMS), where people also have evidence of inflammatory activity in their MRI results. Decisions about price and reimbursement take place at the level of each member state in the context of the national health system of that country.
Treating MS symptoms
People with MS experience a wide range of symptoms caused by damage to their central nervous system. A number of treatments have been tested for MS symptoms and there has been some progress for particular symptoms such as spasticity and gait problems. However, testing of treatments for use in other symptoms such as fatigue and cognitive impairment has been unclear to date.
Balancing treatment benefits with the risk of side effects is difficult in symptom management. For example, a treatment that improves spasticity and pain but worsens mobility may not be worth pursuing. Neurologists need to work closely with each person with MS to find appropriate treatments for that person’s symptoms. Other symptom management techniques such as rehabilitation, energy conservation and exercise also need to be considered.