Treating multiple sclerosis (MS)

Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS).

With MS, your immune system mistakenly attacks your nerves and destroys myelin, their protective coating. If left untreated, MS can eventually destroy all of the myelin surrounding your nerves. Then it may start to harm the nerves themselves.

There’s no cure for MS, but there are several types of treatments. In some cases, treatment can slow the pace of MS. Treatment can also help ease symptoms and reduce potential damage done by MS flare-ups. Flare-ups are the periods when you have symptoms.

However, once an attack has started, you may need another type of medication called a disease modifier. Disease modifiers can change how the disease behaves. They can also help slow the progression of MS and reduce flare-ups.

Some disease-modifying therapies come as infused medications. These infusion treatments may be especially helpful to people with aggressive or advanced MS. Read on to learn more about these medications and how they help treat MS.

Q&A: Administering infusion treatments

Q:

How are infusion treatments given?

A:

These drugs are injected intravenously. This means you receive them through your vein. However, you don’t inject these medications yourself. You can only receive these drugs from a healthcare provider in a healthcare facility.

The Healthline Medical TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Infusion treatment drugs

Today there are four infusible drugs available to treat MS.

Alemtuzumab (Lemtrada)

Doctors give alemtuzumab (Lemtrada) to people who haven’t responded well to at least two other MS medications.

This drug works by slowly reducing your body’s number of T and B lymphocytes, which are types of white blood cells (WBCs). This action may reduce inflammation and damage to nerve cells.

You receive this drug once per day for five days. Then one year after your first treatment, you receive the drug once per day for three days.

Natalizumab (Tysabri)

Natalizumab (Tysabri) works by stopping the damaging immune cells from entering your brain and spinal cord. You receive this drug once every four weeks.

Mitoxantrone hydrochloride

Mitoxantrone hydrochloride is an MS infusion treatment as well as a chemotherapy drug used to treat cancer.

It may work best for people with secondary progressive MS (SPMS) or rapidly worsening MS. That’s because it’s an immunosuppressant, which means it works to stop your immune system’s reaction to MS attacks. This effect can reduce the symptoms of an MS flare-up.

You receive this drug once every three months for a lifetime maximum cumulative dose (140 mg/m2) that will likely be reached within two to three years. Because of the risk of serious side effects, it’s only recommended for people with severe MS.

Ocrelizumab (Ocrevus)

Ocrelizumab is the newest infusion treatment for MS. It was approved by the Food and Drug Administration (FDA) in 2017.

Ocrelizumab is used to treat relapsing or primary progressive forms of MS. In fact, it’s the first drug approved to treat primary progressive MS (PPMS).

This medication is thought to work by targeting the B lymphocytes that are responsible for myelin sheath damage and repair.

It’s initially given in two 300-milligram infusions, separated by two weeks. After that, it’s given in 600-milligram infusions every six months.

Side effects of the infusion process

The infusion process itself can cause side effects, which may include:

  • bruising or bleeding at the injection site
  • flushing, or the reddening and warming of your skin
  • chills
  • nausea

You can also have an infusion reaction. This is a drug reaction on your skin.

For all of these drugs, an infusion reaction is more likely to occur within the first two hours of administration, but a reaction can occur up to 24 hours later. Symptoms can include:

  • hives
  • scaly patches on your skin
  • warmness or fever
  • rash

Side effects of the infusion drugs

Each infused drug has its own possible side effects.

Alemtuzumab

The more common side effects of this drug can include:

  • rash
  • headache
  • fever
  • common cold
  • nausea
  • urinary tract infection (UTI)
  • fatigue

This drug can also cause very serious, and potentially fatal, side effects. They can include:

  • autoimmune reactions, such as Guillain-Barré syndrome and organ failure
  • cancer
  • blood disorders

Natalizumab

The more common side effects of this drug can include:

  • infections
  • allergic reactions
  • headache
  • fatigue
  • depression

Serious side effects can include:

  • a rare and deadly brain infection called progressive multifocal leukoencephalopathy (PML)
  • liver problems, with symptoms such as:
    • the yellowing of your skin or the whites of your eyes
    • dark or brown (tea-colored) urine
    • pain in the upper right side of your abdomen
    • bleeding or bruising that occurs more easily than normal
    • tiredness

Mitoxantrone hydrochloride

The more common side effects of this drug can include:

  • low WBC levels, which may increase your risk of infections
  • depression
  • bone pain
  • nausea or vomiting
  • hair loss
  • UTI
  • amenorrhea, or a lack of menstrual periods

Serious side effects can include:

  • congestive heart failure (CHF)
  • kidney failure

Receiving too much of this drug puts you at risk of side effects that can be very toxic to your body, so mitoxantrone should only be used in severe MS cases. These include CHF, kidney failure, or blood issues. Your doctor will watch you very closely for signs of side effects during treatment with this drug.

Ocrelizumab

The more common side effects of this drug can include:

  • infections
  • infusion reactions

Serious side effects can include:

  • PML
  • reactivation of hepatitis B or shingles, if they’re already in your system
  • a weakened immune system
  • cancer, including breast cancer
OTHER INFUSION TREATMENTS In some cases, your doctor may suggest other infusion treatments. These treatments may be used to treat relapses that don’t respond to corticosteroids. They include plasmapheresis, which involves removing blood from your body, filtering it to remove antibodies that may be attacking your nervous system, and sending the “cleansed” blood back into your body through a transfusion. They also include intravenous immunoglobulin (IVIG), an injection that helps to boost your immune system.

Talk with your doctor

Infusion treatments can be a good option to help treat MS symptoms and flare-ups. However, these drugs aren’t right for everyone. They carry risks of rare but serious complications. Still, many people have found them helpful.

If you have progressive MS or are looking for a better way to manage your symptoms, ask your doctor about infusion treatments. They can help you decide if these drugs might be a good choice for you.