There are a variety of treatments for multiple sclerosis (MS) designed to change how the disease progresses, to manage relapses, and to help with symptoms.
Disease-modifying therapies (DMTs) for MS fall into three categories: self-injectable, infusion, and oral. Some of these medications can be taken at home, while others must be given in a clinical setting. Each type of medication has certain benefits as well as potential side effects.
With so many options, it can be hard to decide which treatment to try first.
Your doctor can help you weigh the pros and cons of each choice and how they impact your lifestyle. Here’s more information on each type of medication to help you make an informed decision.
These medications are given by injection, which you can do yourself. You’ll receive training from a healthcare professional and learn the proper way to inject yourself safely.
Self-injectable medications include:
- glatiramer acetate (Copaxone, Glatopa)
- interferon beta-1a (Avonex, Rebif)
- interferon beta-1b (Betaseron, Extavia)
- peginterferon beta-1a (Plegridy)
You can inject these medications either subcutaneously (beneath the skin) or intramuscularly (directly into the muscle). This may involve a needle or an injection pen.
The frequency of injections ranges from daily to once per month.
The side effects of most injectable medications are unpleasant but usually short-lived and manageable. You may experience pain, swelling, or skin reactions at the injection site. Many of these medications may cause flu-like symptoms, as well as liver test abnormalities.
Zinbryta is another medication that was being used. However, it has been voluntarily removed from the market due to concerns about safety, including reports of severe liver damage and anaphylaxis.
If you’re comfortable self-injecting and prefer not to take oral medications daily, injectable treatments might be a good choice for you. Glatopa requires daily injections but others, such as Plegridy, are done less frequently.
These medications are given intravenously in a clinical setting. You can’t take them yourself at home, so you must be able to get to appointments.
Infusion medications include:
- alemtuzumab (Lemtrada)
- mitoxantrone (Novantrone)
- natalizumab (Tysabri)
- ocrelizumab (Ocrevus)
The schedules for infusion medications vary:
- Lemtrada is given in two courses, starting with five days of infusions followed by a second set one year later for three days.
- Novantrone is given every three months, for a maximum of two to three years.
- Tysabri is administered once every four weeks.
Common side effects include nausea, headache, and abdominal discomfort. In rare cases, these medications may cause serious side effects such as infection and heart damage. Your doctor will help you weigh the risks of taking these drugs against the potential benefits.
If you want the help of a clinician when administering your medication and don’t want to take pills every day, infusion medications might be a good choice for you.
You may be able to take your MS medication in pill form, if that’s what you prefer. Oral medications are easy to take and are a good option if you don’t like needles.
Oral medications include:
- cladribrine (Mavenclad)
- dimethyl fumarate (Tecfidera)
- diroximel fumarate (Vumerity)
- fingolimod (Gilenya)
- siponimod (Mayzent)
- teriflunomide (Aubagio)
Side effects of oral medications may include headache and abnormal liver tests.
Aubagio, Gilenya, and Mayzent are taken once per day. Tecfidera is taken twice per day. In your first week on Vumerity, you'll take one pill twice per day. Afterward, you'll take two pills twice per day.
Mavenclad is a short-course oral therapy. Over the course of 2 years, you'll have no more than 20 treatment days. On your treatment days, your dose will consist of either one or two pills.
Taking your medication as prescribed is important for it to be effective. So you need to follow an organized schedule if you take daily oral doses. Setting up reminders for yourself can help you stick to a schedule and take each dose on time.
Disease-modifying therapies are available in different forms, including self-injectable, infusion, and oral treatments. Each of these forms has side effects as well as benefits. Your doctor can help you choose a medication that’s right for you based on your symptoms, preferences, and lifestyle.