RRMS

There is no cure for MS, but there are medications that may help to treat attacks, manage symptoms, and reduce the progression of the disease. If your MS is mild, you may not need any medication.

The following medications are approved by the Food and Drug Administration (FDA):

• Corticosteroids (oral prednisone and intravenous methylprednisolone) reduce the inflammation during relapse.
  • Beta interferons (Avonex, Betaseron, Extavia and Rebif) slow the progress of MS, as well as reduce the number of attacks and lessen their symptoms. Interferons are naturally produced in the human body to help fight infection, and beta interferons have been found to reduce inflammation.
  • Glatiramer acetate (Copaxone) may reduce the number of MS attacks. Doctors believe that glatiramer acetate works by blocking your immune system’s attack on myelin. The drug is injected once a day.
  • Fingolimod (Gilenya) traps immune cells in your lymph nodes. It may reduce attacks of MS and short-term disability.
  • Natalizumab (Tysabri) works by interfering with the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cord.
  • Mitoxantrone is an immunosuppressant that can be harmful to the heart, and is also associated with development of blood cancers like leukemia. Because of these risks, it’s usually only used to treat active severe cases.
  • Teriflunomide (Aubagio) reduces attacks and lesions in people with MS.

Certain MS medications have been shown to increase risks of pregnancy complications, so make sure to talk to your doctor before taking any medications if you are trying to become pregnant, are pregnant, or are breastfeeding.

To decrease relapse frequency and slow progression of the disease, for example, your doctor may prescribe:

• Beta-interferons
• glatiramer acetate, or Copaxone
• fingolimod, or Gilenya.
• teriflunomide, or Aubagio
• dimethyl fumarate, or Tecfidera
• natalizumab, or Tysabri

Other common prescription medications include corticosteroids for inflammation, and muscle relaxants for stiffness and spasms.

Physical therapy and a treatment called plasmapharesis, in which blood is removed from the body, cleaned of antibodies, and returned, can also be helpful in shortening the duration of symptoms of an attack.

There are four basic types of MS. Out of every twenty people diagnosed with MS,

• 17 have relapsing-remitting MS;
• two have primary progressive MS; and
• one has progressive-relapsing MS.

About 65%— or 11 out of 17—people diagnosed with relapsing-remitting MS will go on to develop the fourth type of the disease, secondary progressive MS. If you have relapsing-remitting, secondary progressive with relapses, or progressive-relapsing MS, there are 10 FDA-approved medications that may slow disease progression and decrease frequency of attacks. When choosing one of these disease modifying medications, you and your doctor should take into consideration your symptoms, disease progression, and possible side effects.

• Beta-interferons, with the brand names Avonex, Rebif, Extavia and Betaseron, are among the most commonly prescribed medications, and are administered periodically via injection. Beta interferons work to prevent inflammation, but since they can change cell counts in your bloodstream, periodic blood tests are recommended to protect against infection and/or liver damage. About 40% of people taking beta interferon will experience some flu like side effects with these medication^.
• Glatiramer Acetate, brand name copaxone, is also given via injection daily or three times weekly, and works by inducing immune tolerance to myelin to limit further damage. Glatiramer is associated with less-severe systemic side effects than Beta-interferons, though site reactions can be bothersome.
• Fingolimod, known as Gilenya, is a pill that works by trapping immune cells in the lymph nodes and blocking their entry into the bloodstream and therefore the CNS. Fingolimod has been shown to be more effective than beta-interferons,but can slow your heartbeat and could raise risk of infection, so it isn’t recommended for individuals with certain pre-existing conditions.
• Teriflunomide, or Aubagio, is a pill that works by inhibiting overactive immune cells—and while as effective as high dose high frequency beta-interferon, it may cause liver damage, so there is careful monitoring of liver function in the first six months of treatment.
• Dimethyl fumarate, or Tecfidera, is a twice daily pill that limits oxidative stress to prevent relapses of multiple sclerosis. Almost half of people will have some gastrointestinal side effects or flushing, a sensation of heat or itching and a red blush of the skin, when starting this medication.
• Natalizumab, or Tysabri, is an intravenous medication used to block immune cells from entering the brain and spinal cord, but it may put you at a higher risk for progressive multifocal leukoencephalopathy, or PML, a potentially lethal brain infection.
• Mitoxantrone, or novantrone is approved for rapidly worsening SPMS or severe RRMS, but is very rarely used due to risk of heart failure and leukemia.

In addition to these disease-modifying treatments, corticosteroids are used intermittently to shorten duration of attacks.

Twelve medications have been approved by the FDA for the specific treatment of RRMS, along with progressive-relapsing MS. All twelve medications have demonstrated the ability to reduce the number of relapses—sometimes known as attacks or exacerbations—and the number of new lesions—also known as plaques or scars—by MRI. These medicines may also slow disease progression—and MS specialist recommend beginning one of these prescription medicines at point that RRMS diagnosis is confirmed. These medications have different methods of delivery:

• Six are injectable—Avonex, Betaseron, copaxone, Extavia, Pregridy, Rebif
• Three are oral—Aubagio, Gilenya, Tecfidera
• Three are infused—Lemtrada, Novantrone, Tysabri

Lemtrada is used for those with RRMS that have not had a good response to at least two other disease-modifying medications. Novantrone Is used specifically for those that have worsening RRMS, meaning that the disease has begun to progress, despite treatment with first-line therapies, along with those that have secondary-progressive MS.

New treatment developments include:

• The FDA’s approval of dimethyl fumarate, or Tecfidera—a new oral medication for relapsing MS treatment—that has been shown to reduce MS attack frequency by 50%.
• The identification of Tob1, a molecule associated with immune cells, as a “biomarker”, or indicator that may help determine whether or not an individual’s MS will progress after the first attack.
• Research suggesting that smoking inhibits the effect of interferons, and therefore lessens the potential efficacy of beta-interferon treatment.
• Research suggesting that malfunctions in the mitochondria—the cell’s energy producers— may be a factor in nerve damage caused by MS. Further mitochondrial research is being conducted as a result.
• Trials for “anti-LINGO” therapy, which is aimed at stimulating myelin-regeneration to reverse nerve damage caused by MS.
• Additional trials for a new, more definitive blood-based MS diagnostic test.

Additionally, a clinical trial review committee has recommended that relapsing-progressive MS be categorized as a form of primary-progressive MS in order to make research, diagnosis, and treatment easier following a re-examination of MS categorization guidelines. It may be a while before we know exactly what causes MS or how to stop it, but doctors and scientists are working hard to unravel this potentially debilitating disease. Tremendous progress has been made in treatment options, with the development of 10 new treatments for relapsing MS in the last 20 years. Much is left to do still, particularly in the realm of progressive forms of the disease, as well as remyelination and repair.