Multiple sclerosis (MS) is a condition that damages nerve cells in your brain and spinal cord. It causes symptoms that gradually get worse, as well as symptoms that come on suddenly after a period of being controlled. This sudden appearance of symptoms is called a relapse.
There’s no cure for MS, and the damage it causes cannot be reversed. However, there is medication available that can help manage the condition.
Management focuses on medication that can modify the disease to reduce damage and disability as well as treat relapses. It also involves other drugs that treat symptoms or complications of MS.
There are several types of disease-modifying drugs that work to help change the course of MS. The length of treatment with these medications can vary from a few months to years, depending on how well the drugs work for you.
Your doctor may recommend switching between these drugs throughout the course of your treatment, depending on how well each drug manages your disease and how you tolerate the side effects.
Interferon beta products
Interferon beta-1a (Avonex, Rebif), peginterferon beta-1a (Plegridy), and interferon beta-1b (Betaseron, Extavia) are injectable drugs.
These drugs are made up of proteins that keep certain white blood cells from entering your central nervous system (your brain and spinal cord). It’s thought that these white blood cells damage your myelin cells, which form a protective coating over nerve fibers.
Therefore, preventing these white blood cells from moving into your central nervous system can help slow the damage they do and reduce the number of relapses you have.
You inject these drugs yourself. Your healthcare provider will show you how to do this. The number of injections depends on the drug:
- Rebif: three times per week
- Betaseron: every other day
- Extavia: every other day
- Avonex: once per week
- Plegridy: every two weeks
Glatiramer acetate (Copaxone)
Glatiramer acetate (Copaxone) is a manufactured substance that resembles a basic protein of natural myelin. It’s thought to work by prompting the white blood cells to attack it instead of the myelin cells.
It’s used to treat relapsing-remitting and progressive-relapsing forms of MS.
You inject this drug yourself once per day or three times per week, depending on your dosage. Your healthcare provider will show you how.
Natalizumab (Tysabri) is an antibody that blocks the movement of damaging white blood cells into your brain and spinal cord.
It treats relapsing-remitting and progressive-relapsing forms of MS.
A healthcare provider gives you this drug as an intravenous (IV) infusion. The infusion takes about an hour, and you’ll get it every four weeks.
Mitoxantrone (Novantrone) was originally used to treat cancer. Now it’s also prescribed to treat people with MS. It suppresses the immune system cells that are thought to attack myelin cells.
It’s used to treat secondary-progressive, progressive-relapsing, or worsening relapsing-remitting MS after other drugs haven’t worked.
A healthcare provider gives you this drug as a short IV infusion once every three months.
Alemtuzumab (Lemtrada) is prescribed for people with relapsing forms of MS who have tried at least two other MS medications without success.
It works by reducing the number of specific white blood cells in your body. This action may reduce the inflammation of and damage to nerve cells.
Alemtuzumab is given as a four-hour IV infusion. To start, you receive this drug once per day for five days. Then, 12 months after your first treatment, you receive it again for three more days.
Ocrelizumab (Ocrevus), which was approved in 2017, is the newest infusion treatment for MS. It’s the first drug used to treat primary-progressive MS. It’s also used to treat relapsing forms of MS.
It’s thought that ocrelizumab works by targeting the B lymphocytes that are responsible for damage and repair of the myelin sheath.
Ocrelizumab is given as an IV infusion. To begin, you’ll receive it in two 300-milligram (mg) infusions, separated by two weeks. After that, you’ll receive it in 600 mg infusions every six months.
You’ll also receive a steroid and an antihistamine on the day of each infusion to reduce the risk of reaction to the medication.
Fingolimod (Gilenya) comes as an oral capsule that you take once per day.
It’s the first oral medication approved by the U.S. Food and Drug Administration (FDA) for relapsing-remitting and progressive-relapsing forms of MS.
Fingolimod causes the damaging white blood cells to remain within your lymph nodes. This reduces the chance that they’ll enter your brain or spinal cord and cause damage.
Teriflunomide (Aubagio) is an oral tablet that you take once per day.
It’s used to treat relapsing-remitting and progressive-relapsing forms of MS.
Teriflunomide works by blocking an enzyme that the damaging white blood cells need. As a result, this drug helps decrease the number of these cells, which reduces the damage they can do.
Dimethyl fumarate (Tecfidera)
Dimethyl fumarate (Tecfidera) is an oral capsule that you take twice per day.
It helps control disease progression in people with relapsing-remitting and progressive-relapsing forms of MS.
It’s thought that this drug works by interfering with the activity of certain immune system cells and chemicals to reduce the risk of MS relapse.
While many relapses go away on their own, more severe relapses require treatment.
Inflammation is the cause of MS relapses, and it’s typically treated with corticosteroids. These drugs can reduce inflammation and help make MS attacks less severe. Corticosteroids used to treat MS include:
- dexamethasone (Decadron)
- methylprednisolone (Medrol)
- prednisone (Deltasone)
If corticosteroids don’t work, ACTH (H.P. Acthar Gel) may be prescribed.
ACTH gel is an injection. It works by prompting the adrenal cortex gland to secrete the hormones cortisol, corticosterone, and aldosterone, which help reduce inflammation.
Other drugs can be used to treat specific symptoms or complications from damage that MS has caused.
For walking problems
Dalfampridine (Ampyra) is a tablet you take by mouth twice per day to help improve walking.
Dalfampridine works by blocking the tiny pores in nerve cells called potassium channels. This action may help nerve cells that have been damaged by MS to better send messages between them. Improved nerve impulse conduction improves leg muscle control and strength.
For muscle stiffness or spasms
A doctor will often give muscle relaxants to people with MS who have painful muscle stiffness or muscle spasms. Drugs commonly used to treat these symptoms include:
- baclofen (Lioresal)
- onabotulinumtoxinA (Botox)
- cyclobenzaprine (Fexmid, Flexeril)
- dantrolene (Dantrium)
- diazepam (Valium)
- tizanidine (Zanaflex)
Ongoing fatigue is a common problem for people with MS. For this symptom, your doctor may prescribe a drug such as modafinil (Provigil).
They may also prescribe a drug off-label. “Off-label” means the drug has been approved to treat a different condition but can be used to treat fatigue. These drugs include amantadine (Gocovri) and fluoxetine (Prozac).
Dysesthesia means “bad sensation.” It’s a type of pain that can feel like ongoing burning, wetness, itching, electric shock, or pins and needles. To treat dysesthesia, your doctor may prescribe:
- amitriptyline (Elavil)
- clonazepam (Klonopin)
- gabapentin (Neurontin)
- nortriptyline (Pamelor)
- phenytoin (Dilantin)
Some research has shown that people with MS are more likely to be clinically depressed than the general population. Drugs used to treat depression in people with MS include:
- bupropion (Wellbutrin)
- duloxetine (Cymbalta)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- venlafaxine (Effexor)
Constipation is another common complication of MS. Your doctor may prescribe one of the following drugs to treat it:
- bisacodyl (Dulcolax)
- docusate (Colace)
- magnesium hydroxide (Phillips’ Milk of Magnesia)
- psyllium (Metamucil)
For bladder dysfunction
Bladder dysfunction is also a common complication of MS. Symptoms may include frequent urination, incontinence, hesitancy in starting urination, or frequent nocturia (nighttime urination). Drugs to treat these symptoms include:
- darifenacin (Enablex)
- oxybutynin (Ditropan)
- prazosin (Minipress)
- solifenacin (VESIcare)
- tamsulosin (Flomax)
- tolterodine (Detrol)
For sexual dysfunction
Both men and women with MS tend to have higher rates of sexual dysfunction than the general population.
Oral medications that may be prescribed to help treat erectile dysfunction include:
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra)
Older drugs that must be injected directly into the penis are also available. These drugs aren’t used as much now that oral drugs are available. They include alprostadil (Caverject). A drug that may be used off-label for this purpose is papaverine.
Women may experience problems such as reduced feeling in the vagina or clitoris, or vaginal dryness. Currently there are no drugs available to treat these problems. However, for vaginal dryness, women can use water-soluble personal lubricants that are available over the counter.
Many different types of drugs are available to help you manage your MS. The type of drugs that may be best for you depends on the type of MS you have and the symptoms you experience.
Work with your doctor to create a plan to manage your MS symptoms and to help prevent further damage from the disease. Sticking to your treatment plan can help you feel better and slow the progression of your condition.