Managing the symptoms of multiple sclerosis is one of the most important parts of dealing with the disease. Because MS can’t be cured, relapses will happen over time, and those can be difficult on a level that is simply irritating or more severe to the point of being debilitating.
The use of certain medications to help manage multiple sclerosis relapses is essential, especially since some medications not only help reduce the severity of the symptoms but also make relapses happen less frequently. There are eight very common treatments used to help manage multiple sclerosis relapses, some of which are not the first line of treatments but may become necessary if others don’t pan out.
A list of possible medications and treatments for MS
- Beta interferon
- Dimethyl fumarate
- Other immunosuppressants
Let’s go over each one in detail so you understand the pros and cons to each.
For flareups and milder symptoms in a relapse, MS patients will likely first be prescribed corticosteroids. These are most effective in injections or intravenously, though they can also be given as pills. Steroids have an anti-inflammatory effect that can ease the suffering caused by MS relapses, especially since a number of symptoms are due to the inflammation rather than immediate damage to the nerves. When prescribed as pills, these are typically a ten day course of treatment. As injections or IV applications, they are usually given in a three to five day course, depending on the severity of the symptoms, the strength of the steroids, and the patient’s general health.
Interferon is anti-inflammatory in nature but is also an immunosuppressant. What this means is that it is used to increase the production and activity of suppressor lymphocytes. These cells are created in order to inhibit the body from activating other immune cells that would attack foreign substances. In the case of MS, this would prevent the antibodies that attack the nerves from being activated and could then lessen symptoms of an active relapse or perhaps even stave off a relapse for an indefinite amount of time. Because it is an immunosuppressant, however, it can also lead to a risk of other types of infections.
Glatiramer acetate is an injectable medication. It is a synthetic protein that is similar to the chemical makeup of myelin, the substance that coats the nerves in the spinal cord and brain to protect them and increase the speed of electrical impulses. This is the substance attacked by the immune system, and glatiramer acetate simulates this substance. Though doctors and scientists don’t understand why, it appears to block the T-cells that damage myelin through some mechanism, which reduces damage, inflammation, and the symptoms experienced.
This immunomodulatory drug is a form of immunosuppressant that doesn’t seem to be as harsh on the system, reducing the risk of other types of infections compared to some medications. Taken as a pill, it works by inhibiting certain activated T-cells that divide rapidly from reproducing, a process that seems to be part of the driving force behind MS and its severity. Reduction of the division process could ease symptoms and prolong remissions so that relapses happen less frequently.
Another form of immunosuppressant, fingolimod has proven to stave off relapses, effectively reducing the number suffered in MS patients by half over the course of a two year treatment period. It traps the lymphocytes that would attack the nerves in the central nervous system (CNS) inside the lymph nodes, preventing an autoimmune reaction. It is a pill taken once a day.
Also used in treating plaque psoriasis (another autoimmune disease), dimethyl fumarate works as an anti-inflammatory, and while it isn’t completely understood how it treats multiple sclerosis, it seems to reduce the production of the types of lymphocytes that cause inflammation in the CNS. This particular drug is prescribed with care and attention due to potential for liver damage, but mostly, side effects are of a gastrointestinal nature.
If none of these medications work to help reduce the incident of relapses as well as to manage the symptoms when they do occur, multiple sclerosis patients have other options. Doctors may treat with additional types of immunosuppressant drugs.
Natalizumab is a monoclonal antibody treatment that is also used for Crohn’s disease. It is given as an infusion intravenously every four weeks. This particular drug is used to prevent the antibodies that attack the CNS from passing adhering to or passing through the blood-brain barrier, thus reducing the likelihood of a relapse. In many cases, this drug also prevents these immune cells, which also cause inflammation in the CNS, from being absorbed into the intestinal lining, where they may also cause problems.
Also in the monoclonal antibody category is ocrelizumab, though it has a different mechanism of action. With this drug, there is a marker on B lymphocytes, known as CD20, that ocrelizumab targets, which allows for the destruction of these cells prior to their production of the antibodies that attack the CNS and cause destruction of the myelin coating. This, too, is an intravenous infusion but only requires two treatments a year.
If no other type of drug assists in managing relapses of multiple sclerosis, a doctor may recommend alemtuzumab, a form of chemotherapy. This drug targets all T and B cells, which are the immune cells created to destroy viruses and bacteria that enter the body but, in MS patients, can create antibodies that attack the CNS coating. The treatment is used to kill the offending cells before they can reach the brain and spinal cord to create the antibodies. This is delivered in two courses, the first lasting five days and the second in three days a year later. Serious side effects can occur, including difficult to treat infections, hives, extreme headaches, and even more serious problems such as thyroid disease. However, it does show significant reduction of relapses compared to beta interferon treatments.