Multiple sclerosis (MS) is an autoimmune disorder in which the body’s immune system attacks the myelin covering 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 make up the largest category of DMTs. They’re 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 can 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 can 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 can 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 can 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: daily, subcutaneous injection
  • Common side effects can 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)

Plegridy (pegylated interferon beta-1a)

  • Benefit: works as immune system modulator, has antiviral properties
  • Dose frequency and method: every two weeks, subcutaneous injection
  • Common side effects can 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 can 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 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 five days; one year later, daily for three days
  • Common side effects can include: nausea, vomiting, diarrhea, headache, rash, itching
  • Warnings include: can cause cancer and idiopathic thrombocytopenic purpura (IPT), 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 three months (lifetime limit of 8 to 12 infusions over two to three years)
  • Common side effects can 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

Ocrevus (ocrelizumab)

  • Benefit: targets B cells, which are WBCs that damage nerves
  • Dose frequency: two weeks apart for first two doses; every six months for all later doses
  • Common side effects can 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 four weeks
  • Common side effects can include: headache, joint pain, fatigue, depression, abdominal discomfort
  • Warnings include: can increase 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. Taken daily or twice daily, oral medications are the easiest to self-administer but require that you maintain a regular dosing schedule.

Aubagio (teriflunomide)

  • Benefit: works as immune system modulator, inhibits nerve degeneration
  • Dose frequency: daily
  • Common side effects can 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

Gilenya (fingolimod)

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

Tecfidera (dimethyl fumarate)

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

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 are enough to cause you to want to skip treatments, talk to your doctor. They can help you choose the best option for you.