While multiple sclerosis can’t be cured, it can be treated to help minimize symptoms and overall damage caused by the disease. Some patients choose to simply take anti-inflammatory and pain medications to assist with symptom management. However, there are lots of other options, especially for those with relapsing-remitting multiple sclerosis.
One of the main ways to help reduce relapses for RRMS patients is with disease-modifying therapies. There are at least ten different medications approved for use in MS patients for this purpose, allowing patients to live a fuller life with fewer relapses and less severity. In fact, there is some evidence that progression may be stalled or stopped entirely in some instances.
What causes multiple sclerosis?
To understand how DMTs, or disease modifying therapies, work, it’s important to understand the disease they treat. Multiple sclerosis is an autoimmune, degenerative disease. In MS patients, the immune system attacks myelin, the substance that coats the nerves in the brain and spinal cord and protects them. It also works to speed the signaling of electrical pulses through the nerves to create reactions in the body.
In attacking that myelin, the immune system first destroys the substance and then damages the nerves. In addition, all of this causes damaging inflammation to the central nervous system, furthering the symptoms of multiple sclerosis.
In the vast majority of cases, a patient is first diagnosed with relapsing-remitting multiple sclerosis, which means symptoms are not constant and do not increase in severity with each episode. It’s essential to get DMTs into place during this phase to help with lessening symptoms and progression.
How disease-modifying therapies work
Through a number of long-term studies, certain medications have shown promise in slowing the progression of or lessening the impact of multiple sclerosis by altering the immune system in some way. Each drug is different, but all seem to produce results in patients with RRMS.
- Fewer relapses
- Less severe symptoms during relapses
- Shorter relapses
- Reduced build up of disability based on inability to completely recover from a relapse
These therapies are prescribed by a doctor based on the frequency of relapses but may also be used in clinically isolated syndrome, which is diagnosed in patients with a single episode of these symptoms without recurrence. For these patients, there is hope that a DMT will reduce the possibility of a relapse that pushes a full diagnosis of MS.
Treating during no evidence of disease activity (NEDA)
Recent studies have shown doctors two things about MS that haven’t been noticed before:
- Permanent neurological damage can be caused in the earliest stages of MS, which means that earlier diagnosis and treatment are crucial, especially in the use of DMTs to reduce long term damage and disability.
- Even when symptoms aren’t visible, changes to the nervous system due to MS may happen, resulting in new lesions on the brain that worsen symptoms or create more damage. This silent activity, called NEDA (no evidence of disease activity) is a new focus in treating MS and can be addressed with DMTs.
What disease-modifying therapies are available for MS?
Unless the patient began using a DMT when diagnosed with RRMS and has advanced to secondary progressive MS (SPMS), DMTs are not recommended for treating any other type of multiple sclerosis except for relapsing-remitting MS. Those with RRMS on average see at least one to two relapses a year, and a DMT can help reduce that or make them easier to handle. Ten DMTs approved for use include:
- Glatiramer acetate (Copaxone, Glatopa, generic) – This injection contains a synthetic protein that is similar to the myelin protein in the body and blocks the T-cells that are created by the immune system to attack and damage the myelin coating the nerves in the central nervous system (CNS).
- Interferon b-1a (Avonex, Rebif), interferon b-1b (Betaseron, Extavia) – Also an immunomodulator injection, interferon is given via intramuscular shot and works as an anti-inflammatory that reduces relapses and can help prevent progression of MS.
- Pegylated interferon b-1a (Plegridy) – This is similar to other interferon treatments but injection is only required every two weeks and is subcutaneous (under the skin) rather than intramuscular.
- Dimethyl fumarate (Tecfidera) – While the method of action in treating MS is not quite understood, this anti-inflammatory oral medication that is taken twice daily and reduces the long term impact of MS on the nerves.
- Fingolimod (Gilenya) – Also an oral medication, this works to suppress parts of the immune system, resulting in cutting back relapses of MS by half (over a two year period). It works by holding lymphocytes that create an autoimmune reaction in the lymph nodes rather than releasing them.
- Teriflunomide (Aubagio) – This is a once daily oral medication that works by decreasing the number of lymphocytes in the system, therefore reducing the possibility of attack and decreasing relapses in MS.
- Alemtuzumab (Lemtrada) – Used under other names to treat some cancers, this is an intravenous drug that decreases episodes and delays disability in RRMS patients by reducing the number of lymphocytes in the body. This is a monoclonal antibody treatment, or biologic, not a chemotherapy.
- Mitoxantrone (Novantrone) – This is an intravenous chemotherapy drug and is classified as an antitumor antibiotic that is powerful in suppressing the immune system. It’s not prescribed as a first option.
- Natalizumab (Tysabri) – Also used in the treatment of Crohn’s disease, this is an intravenous monoclonal antibody treatment that helps block the passage of inflammatory immune cells through the blood-brain barrier, so they can’t attack the central nervous system.
- Ocrelizumab (Ocrevus) – This monoclonal antibody infusion targets a specific protein on the surface of B lymphocytes in the immune system, destroying those cells before they can evolve and produce the antibodies that attack the nerves in the brain and spinal cord.
With a variety of options that can be employed in the early stages of multiple sclerosis, there is a lot of promise in suppressing relapses of symptoms of the disease. DMTs also treat between relapses, preventing extensive damage so that there is less buildup of disability over time. With less frequent symptoms and slowing the progression of the disease, patients on disease-modifying therapies can expect a better quality of life.