Most people who are diagnosed with multiple sclerosis (MS) initially have relapsing-remitting multiple sclerorsis (RRMS). Over time, this can change.
RRMS causes alternating periods of symptoms, known as relapses, and symptom-free periods called remission. In most cases, RRMS will eventually become secondary progressive MS (SPMS). In SPMS, damage to the brain and spinal cord progresses gradually over time without remission.
Some people have the “active” form of SPMS. The disease progresses over time, but they also continue to have periods of low disease activity and relapses.
Disease-modifying therapies (DMTs) are drugs that slow MS progression, lower the number of relapses, and help prevent brain and spinal cord damage. Until a few years ago, most DMTs only worked in people with RRMS. That’s changed, thanks to the approval of a few new drugs designed to treat SPMS, too.
Several DMTs are Food and Drug Administration (FDA)-approved specifically to treat types of SPMS.
Siponimod (Mayzent)
In 2019, the
Because this drug acts on the cells of the immune system, it could increase the risk of infection. A doctor or healthcare professional may want to check your blood cell count before you start taking it. If you’re pregnant or planning to become pregnant, you shouldn’t use siponimod.
The most common side effects from siponimod include headache and high blood pressure. Other possible risks with this medication are:
- inflammation in the macula of the eye, called macular edema
- vision changes
- slowed heart rate
- lung problems
- liver damage
- developmental issues for a fetus
Cladribine (Mavenclad)
Shortly after approving siponimod, the
This medication is also taken orally as a pill. It’s taken in two treatment cycles over a period of 2 years. Each cycle lasts for up to 20 days.
In studies, cladribine lowered the number of relapses and slowed MS progression.
A doctor may recommend this drug only if other MS medications haven’t worked for you, because of its risks. It has a black box warning — the strongest warning a medication can carry about possible side effects — because it may increase the risk of cancer and developmental issues for a fetus.
Before starting this treatment, talk with a doctor about whether you’re at increased risk of cancer.
People who are sexually active and fertile, meaning that they or their partner could potentially become pregnant, need to use contraceptives if they take cladribine. If you become pregnant, you should stop taking it right away.
Other risks related to this medication are:
- an increased risk of colds, shingles, and other infections
- headaches
- low white blood cell count and other blood cell counts
- liver damage
Mitoxantrone (Novantrone)
Mitoxantrone was originally used as a cancer medication. It’s now been FDA-approved for treating certain types of MS, including SPMS.
The medication stops immune cells from attacking the myelin sheath that protects nerves. It may help reduce disability in people with SPMS.
Mitoxantrone is taken as an infusion, given once every 3 months.
Side effects include an increased risk of congestive heart failure. A doctor may check your heart health before you start taking this drug. It’s not recommended for use during pregnancy.
Ofatumumab (Kesimpta)
Kesimpta is a DMT that has FDA approval for treating relapsing forms of MS in adults, including active SPMS.
It’s a type of drug known as a monoclonal antibody. It lowers the activity of some types of immune B cells. These cells may contribute to nerve damage in people with MS.
Kesimpta comes in prefilled pens or syringes that you can inject at home. The first three doses will be weekly, and then there’ll be a break of 1 week. After that, you’ll use them monthly.
Common side effects include the following, though other adverse effects may also occur:
- swelling, itching, or pain around the injection site
- fever, headache, and other flu-like symptoms
- low levels of some types of antibodies
- a higher risk of an upper respiratory tract infection
It’s not suitable for use during pregnancy, while breastfeeding, or if you have an active hepatitis B infection.
Ponesimod (Ponvory)
Ponvory is a DMT that has FDA approval for treating relapsing forms of MS, including active SPMS.
It’s a type of drug known as a selective sphingosine 1-phosphate receptor 1 modulator. Scientists believe it helps the lymph nodes retain certain white blood cells, which stops them from circulating in the blood. This prevents them from entering the brain and spinal cord.
People take it as a tablet, once daily.
Possible adverse effects include:
- a higher risk of an upper respiratory tract infection
- liver problems
- high blood pressure
It’s not suitable for people with a history of heart problems.
If you’re living with active SPMS, the National MS Society recommends trying one of the many DMTs that are FDA-approved to treat relapsing forms of MS. The following are some of the medications that may reduce how often you experience relapses:
- alemtuzumab (Lemtrada)
- dimethyl fumarate (Tecfidera)
- fingolimod (Gilenya)
- glatiramer acetate (Copaxone)
- interferon beta-1a (Avonex, Rebif)
- interferon beta-1b (Betaseron, Extavia)
- natalizumab (Tysabri)
- ocrelizumab (Ocrevus)
- teriflunomide (Aubagio)
- ozanimod (Zeposia)
- diroximel fumarate (Vumerity)
- ponesimod (Ponvory)
Some treatments for SPMS target specific symptoms. These medications won’t generally slow the progression of the disease, but they may help you feel better and improve your quality of life.
Some medications may help with relapses, if you have them, including methotrexate and corticosteroids. A doctor can also prescribe treatments for specific symptoms, such as:
- amantadine (Gocovri, Oxmolex), modafinil (Provigil), and methylphenidate (Ritalin) to relieve tiredness
- citalopram (Celexa), fluoxetine (Prozac), and sertraline (Zoloft) to treat depression
- dalfampridine (Ampyra) to improve walking ability
- duloxetine (Cymbalta), gabapentin (Neurontin), and venlafaxine (Effexor) to ease pain
- muscle relaxants to relieve muscle stiffness and spasms
- oxybutynin (Oxytrol), tamsulosin (Flomax), and tolterodine (Detrol) to treat bladder problems
Medication isn’t the only way to manage SPMS. Lifestyle changes can be helpful, too.
Exercise and physical therapy may help improve your mobility and lower pain. Time management strategies can help you avoid fatigue, while cooling devices can also ease symptoms.
SPMS can be managed with medications. These treatments may focus on changing the course of the disease or treating specific symptoms.
Newly approved medications for SPMS have made it easier to slow the disease, especially for people who continue to have relapses. Lifestyle changes may also make a difference.
A doctor can advise you about your treatment options and provide more information about new medications. Discuss the possible benefits and risks before you decide on a treatment.