Medication Treatment Options for Multiple Sclerosis (MS)

What is multiple sclerosis?

Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. With MS, the immune system attacks the protective shell (myelin) of nerve fibers throughout the body. Scar tissue then accumulates around the nerves, which eventually causes nerve damage. Once the nerves are damaged with scar tissue, they cannot receive signals sent from the brain to properly operate. Since the nervous system controls every movement of the body, MS can cause vision issues, movement and muscle control problems, balance issues, and other health complications. The exact cause of multiple sclerosis is not yet clear.

Medication treatment options

A variety of treatment options are available for multiple sclerosis, including medication treatment. The medications used to treat MS work in different ways and are prescribed according to the type of MS, severity of symptoms, and disease progression.

Disease-modifying therapies (DMTs) aim to reduce the number of relapses, slow the progression of symptoms, and limit new lesions. Medications to treat relapses are also available.

Disease-modifying therapies

Disease-modifying therapies include oral, injectable and infused medications.

Oral medications

Oral medications to treat multiple sclerosis are typically taken once or twice daily. These medications include, but are not limited to, the following:

• Fingolimod decreases relapse rate by reducing damage to nerve cells caused by inflammation.
• Teriflunomide reduces relapse rate by inhibiting an enzyme that white blood cells need in order to do damage.
• Siponimod slows progression and reduces relapse rate by keeping certain white blood cells out of the central nervous system.
• Dimethyl fumarate reduces relapse rate by lowering the inflammatory response of the immune system.
• Diroximel fumarate works in the same way as dimethyl fumarate but may have fewer gastrointestinal side effects.
• Low-dose naltrexone reduces inflammation by releasing endorphins. Naltrexone for multiple sclerosis is an off-label use of the medication; it is typically used to manage alcohol and opioid addiction.

Injectable medications

Injectable medications are injected under the skin or into muscle. The frequency of injections varies from every other day to 1-3 times per week. These medications include the following:

• Interferon beta-1a and beta-1b reduce the frequency and severity of relapses by preventing certain damaging white blood cells from entering the brain and spinal cord.
• Glatiramer acetate helps to stop the immune system’s attack on myelin by blocking certain T-cells in the immune system.
• Peginterferon beta-1a works in the same way as interferon beta-1a, but it lasts longer, which means it can be injected less frequently than interferon beta-1a.

Infused medications

Infused medications are intravenous (IV) infusions performed by a medical professional. The frequency of infusions varies widely — anywhere from once every four weeks to once every year. These medications include the following:

• Natalizumab blocks immune cells from moving from the bloodstream to the brain and spinal cord.
• Alemtuzumab decreases inflammation of and damage to nerve cells by reducing the number of white blood cells in the body.
• Ocrelizumab reduces relapse rate and slows MS progression by targeting certain white blood cells that contribute to nerve damage.
• Mitoxantrone hydrochloride treats the most severe forms of MS by suppressing immune system cells that attack myelin.

Medications for multiple sclerosis relapses

In addition to disease-modifying therapies, certain medications can be used to treat severe relapses. These medications include the following:

• Corticosteroids reduce inflammation, which can lessen the severity of MS attacks.
• Corticotropin reduces inflammation by prompting the adrenal cortex to secrete specific hormones. Adrenocorticotropic hormone (ACTH) is an injectable form of corticotropin that is approved to treat MS relapse.