Many factors go into consideration for the treatment of a patient who has multiple sclerosis. During an acute exacerbation, steroids given through an IV are commonly prescribed, and often help patients recover more rapidly. If a patient cannot receive steroids, plasma exchange can be used.
Once a diagnosis of multiple sclerosis has been confirmed, disease-modifying therapy is often recommended. This therapy may decrease the number of exacerbations that a patient experiences or decrease the severity of an exacerbation. In addition, many of these therapies have been shown to decrease the potential for developing long-term disability.
Multiple sclerosis medications
Interferon therapies (Avonex, Betaseron, Extavia, Rebif, Plegridy) must be given by an injection. The frequency of injections ranges from every other day to every other week. Some patients develop flu-like symptoms or nodules under the skin following each injection; other patients may develop severe depression.
Glatiramer acetate (Copaxone) works along a different path than the interferons, but is still thought to modify the immune system and has been shown to reduce relapses. There are some oral medications which have been approved to treat multiple sclerosis, including fingolimod (Gilenya) and teriflunomide (Aubagio).
Although these medications are dosed orally, there is a risk of significant side effects:
- including heart disease (fingolimod), or
- severe liver injury (teriflunomide).
Another oral agent, dimethyl fumarate (Tecfidera), may function by preventing immune cells from attacking cells located in the central nervous system, and may have anti-inflammatory properties.
Dalfampridine (Ampyra), has been approved to specifically help with walking problems caused by multiple sclerosis. The specific way in which this medication works is unknown. There is a risk that this medication may cause seizures, even in patients without a history of seizure or epilepsy. As such, the use of this medication needs to be monitored carefully.
Natalizumab (Tysabri) is a monoclonal antibody, and has been approved for patients who have relapsing-remitting multiple sclerosis. Because of significant side effects, including the risk of severe brain infection, it is typically used for patients who have failed to respond to one of the interferon products or who have been diagnosed with very active disease.
Alemtuzumab (Lemtrada) can also decrease the relapse rate in relapsing-remitting multiple sclerosis. However, because of the risk of serious side effects, it is currently limited to use in patients who have failed other agents.
Mitoxantrone (Novantrone) is a chemotherapy agent for leukemia or prostate cancer, which has been shown to be of benefit in treating secondary-progressive multiple sclerosis, progressive-relapsing multiple sclerosis, and advanced relapsing-remitting multiple sclerosis.
Of note, mitoxantrone and Betaseron are the only medications identified to help patients with relapsing-primary multiple sclerosis.