Multiple sclerosis (MS) is an autoimmune disorder in which the body’s immune system attacks the myelin covering (myelin sheath) of your nerves. Eventually, this causes damage to the nerves themselves.

There’s no cure for MS, but treatment can help manage the symptoms and slow the progression of the disease.

Disease-modifying therapies (DMTs) are designed to slow the long-term progression of the disease, reduce relapses, and prevent new damage from occurring.

DMTs can be taken orally or by injection. Injections can be either self-injected at home or given as intravenous infusions in a clinical setting.

Both oral and injectable medications have benefits and potential side effects. Many come with specific warnings from the Food and Drug Administration (FDA).

There are many factors to consider when deciding between oral and injectable treatments. For example, oral medications are taken daily, while most injectable medications are taken less frequently.

Your doctor can help you weigh the risks against the benefits and decide on the best option for you.

Your preference is important in the selection of a treatment plan. Important things you’ll want to take into consideration are:

  • the medication’s effectiveness
  • its side effects
  • the frequency of doses
  • the method used to administer the medication

Self-injectable medications are used for the long-term treatment of relapsing-remitting MS (RRMS).

A medical professional will train you in the injection process so that you can safely administer your own dose. Most of these medications can cause redness, swelling, and pain at the injection site, in addition to other side effects.

Avonex (interferon beta-1a)

  • Benefit: works as immune system modulator, has antiviral properties
  • Dose frequency and method: weekly, intramuscular injection
  • Common side effects include: headache, flu-like symptoms
  • Warnings include: liver enzymes and complete blood count (CBC) may need to be monitored

Betaseron (interferon beta-1b)

  • Benefit: works as immune system modulator, has antiviral properties
  • Dose frequency and method: every other day, subcutaneous injection
  • Common side effects include: flu-like symptoms, low white blood cell (WBC) count
  • Warnings include: liver enzymes and CBC may need to be monitored

Copaxone (glatiramer acetate)

  • Benefit: works as immune system modulator, blocks attack on myelin
  • Dose frequency and method: daily or three times per week, subcutaneous injection
  • Common side effects include: flushing, shortness of breath, rash, chest pain
  • Warnings include: injection sites can become permanently indented because fatty tissue is destroyed (as a result, careful rotation of injection sites is recommended)

Extavia (interferon beta-1b)

  • Benefit: works as immune system modulator, has antiviral properties
  • Dose frequency and method: every other day, subcutaneous injection
  • Common side effects include: flu-like symptoms, headache
  • Warnings include: liver enzymes and CBC may need to be monitored

Glatopa (glatiramer acetate)

  • Benefit: works as immune system modulator, blocks attack on myelin
  • Dose frequency and method: subcutaneous injection, 20 milligrams (mg) daily or 40 mg three times per week
  • Common side effects include: redness, swelling, pain at the injection site
  • Warnings include: injection sites can become permanently indented because fatty tissue is destroyed (as a result, careful rotation of injection sites is recommended)

Kesimpta (ofatumumab)

  • Benefit: depletes some immune B cells that cause nerve damage
  • Dose frequency and method: injection under the skin weekly for the first 4 weeks, then monthly
  • Common side effects include: reactions near the injection site; fever and other flu-like symptoms; upper respiratory tract infection and headache
  • Warnings include: don’t use it if you have an active hepatitis B infection or if you have had a live or live attenuated vaccine in the last 4 weeks or are going to have one in the next 2 weeks

Plegridy (pegylated interferon beta-1a)

  • Benefit: works as immune system modulator, has antiviral properties
  • Dose frequency and method: every 2 weeks, subcutaneous injection
  • Common side effects include: flu-like symptoms
  • Warnings include: liver enzymes may need to be monitored

Rebif (interferon beta-1a)

  • Benefit: works as immune system modulator, has antiviral properties
  • Dose frequency and method: three times per week, subcutaneous injection
  • Common side effects include: flu-like symptoms
  • Warnings include: liver enzymes may need to be monitored

Another type of injectable option for treating MS is intravenous infusion. Instead of entering your system intramuscularly or subcutaneously, infusions go directly into a vein.

The infusions must be given in a clinical setting by a trained professional. The doses aren’t administered as often.

Intravenous infusions can result in an increased risk of infections in addition to other side effects.

Ocrelizumab (Ocrevus) is the only medication that’s FDA approved for people with primary progressive MS (PPMS). It’s also approved to treat RRMS.

Lemtrada (alemtuzumab)

  • Benefit: suppresses myelin-damaging immune cells
  • Dose frequency: daily for 5 days; 1 year later, daily for 3 days
  • Common side effects include: nausea, vomiting, diarrhea, headache, rash, itching
  • Warnings include: can cause cancer and idiopathic thrombocytopenic purpura (ITP), a bleeding disorder

Mitoxantrone hydrochloride

This medication is only available as a generic drug.

  • Benefit: works as immune system modulator and suppressor
  • Dose frequency: once every 3 months (lifetime limit of 8 to 12 infusions over 2 to 3 years)
  • Common side effects include: hair loss, nausea, amenorrhea
  • Warnings include: can cause heart damage and leukemia; only appropriate for people with severe cases of RRMS, due to the high risk of serious side effects

Novantrone (mitoxantrone)

  • Benefit: reduces the activity of T cells, B cells, and macrophages that appear to play a key role in damaging the myelin sheath
  • Dose frequency and method: an infusion lasting 5–15 minutes, every 3 months, but the most you can receive is 8 to 12 infusions over 2 to 3 years
  • Common side effects include: allergic reaction, pain and swelling at the injection site, nausea and vomiting, arrhythmia and other heart problems
  • Warnings include: this is a chemotherapy drug that is not suitable for people with heart problems; it may increase the risk of developing acute myeloid leukemia

Ocrevus (ocrelizumab)

  • Benefit: targets B cells, which are WBCs that damage nerves
  • Dose frequency: 2 weeks apart for first two doses; every 6 months for all later doses
  • Common side effects include: flu-like symptoms, infection
  • Warnings include: can cause cancer and, in rare instances, life-threatening infusion reactions

Tysabri (natalizumab)

  • Benefit: inhibits adhesion molecules, which disrupt the immune system
  • Dose frequency: every 4 weeks
  • Common side effects include: headache, joint pain, fatigue, depression, abdominal discomfort
  • Warnings include: can increase the risk of progressive multifocal leukoencephalopathy (PML), a potentially fatal brain infection

If you’re not comfortable with needles, there are oral options for treating MS. Oral medications are the easiest to self-administer but require that you maintain a regular dosing schedule. Most are taken once or twice daily.

Aubagio (teriflunomide)

  • Benefit: works as immune system modulator, inhibits nerve degeneration
  • Dose frequency: daily
  • Common side effects include: headaches, liver changes (such as an enlarged liver or elevated liver enzymes), nausea, hair loss, reduced WBC count
  • Warnings include: can cause severe liver injury and birth defects

Bafiertam (monomethyl fumarate)

  • Benefit: most likely reduces the inflammation caused by the immune response in MS and may help protect the brain and spinal cord
  • Dose frequency and method: by mouth, one 95-mg capsule twice a day for 7 days, increasing to two capsules daily after 7 days
  • Common side effects include: an allergic or sensitivity reaction, gastrointestinal symptoms, and a higher risk of some types of infection
  • Warnings include: not suitable for people with a low WBC count

Gilenya (fingolimod)

  • Benefit: blocks T cells from leaving lymph nodes
  • Dose frequency: daily
  • Common side effects include: flu-like symptoms, elevated liver enzymes
  • Warnings include: can cause changes in blood pressure, liver function, and heart function

Mavenclad (cladribine)

  • Benefit: reduces the number of T and B lymphocytes, which play a key role in the immune attack in people with MS, but it does not continuously suppress the immune system
  • Dose frequency and method: divided into two treatment courses:
    • first course: of an initial dose, followed by another dose 23–27 days later
    • second course: one dose at least 43 weeks after the previous course followed by a second dose 23–27 days later
  • Common side effects include: upper respiratory tract infection, headache, reduced levels of lymphocytes, a type of WBC
  • Warnings include: may increase the risk of cancer; not suitable for anyone who wishes to conceive or become pregnant, whether male or female; not suitable during pregnancy

Ponesimod (Ponvory)

  • Benefit: helps the lymph nodes retain certain white blood cells. This stops them circulating in the blood and entering the brain and spinal cord.
  • Dose frequency and method: orally, usually as a 20 mg tablet, once daily.
  • Common side effects include: an increased risk of upper respiratory tract infection, liver problems, high blood pressure
  • Warnings include: not suitable for people with a history of heart problems

Siponimod (Mayzent)

  • Benefit: acts on immune cells to slow MS progression and reduces the number of relapses
  • Dose frequency and method: oral, a 2 mg tablet once daily
  • Common side effects include: slow heart rate, headache, high blood pressure, eye problems, slow heart rate, a higher risk of infections, lung problems, liver damage
  • Warnings include: not suitable for people with a history of heart problems or stroke and those who are pregnant or planning to become pregnant

Tecfidera (dimethyl fumarate)

  • Benefit: has anti-inflammatory properties, protects nerves and myelin from damage
  • Dose frequency: twice daily
  • Common side effects include: gastrointestinal changes, reduced WBC count, elevated liver enzymes
  • Warnings include: can cause severe allergic reactions, including anaphylaxis

Vumerity (diroximel fumarate)

  • Benefit: most likely modulates the immune response to reduce inflammation and may prevent damage to the brain and spinal cord
  • Dose frequency and method: by mouth, one capsule per day for 7 days, increasing to two capsules after 7 days with a high fat or high calorie snack or meal
  • Common side effects include: flushing, redness, itching, rash, nausea, vomiting, diarrhea, stomach pain, or indigestion
  • Warnings include: an allergic or sensitivity reaction, gastrointestinal symptoms, a higher risk of various types of infection

Zeposia (ozanimod)

  • Benefit: reduces cell damage due to inflammation by preventing certain WBCs from entering the central nervous system
  • Dose frequency and method: by mouth, one capsule daily
  • Common side effects include: liver problems, high blood pressure, reduced heart rate, breathing problems, a higher risk of certain types of upper respiratory tract infections and other infections
  • Warnings include: not suitable for people with a history of heart problems or stroke

The goal of MS treatment is to manage symptoms, control relapses, and slow the long-term progression of the disease.

Injectable MS treatments come in two forms: self-injectables and intravenous infusions. Most injectables don’t have to be taken as often as oral medications, which are taken daily.

All MS treatments have benefits, side effects, and risks. The most important thing is that you take your treatment as prescribed, regardless of what treatment you’re on.

If the side effects cause you to want to skip treatments, talk with your doctor. They can help you choose the best option for you.

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