There are several factors to discuss with a doctor when starting treatment for multiple sclerosis (MS), including your treatment goals and which options are best for you.
There are four main types of MS, and relapsing-remitting multiple sclerosis (RRMS) is the most common. It’s also the type most people receive as a first diagnosis.
There are currently 23 drugs approved by the Food and Drug Administration to prevent brain and spinal cord damage that leads to MS symptoms. Experts often refer to these medications as “disease-modifying drugs” because they can slow the worsening of MS.
As you start your first MS treatment, here are a few things to know about the medications for RRMS, how they can help you, and what side effects they might cause.
Before you receive a new treatment plan, here are a few questions to ask the doctor:
- Why are you recommending this treatment?
- How will it help my MS?
- How do I take it? How often do I need to take it?
- How much does it cost?
- Will my health insurance plan cover the cost?
- What side effects could it cause, and what should I do if I have side effects?
- What are my other treatment options, and how do they compare with the one you recommend?
- How long should it take before I can expect to notice results?
- What should I do if my treatment stops working?
- When is my next appointment?
- What are the signs that I should call you in between scheduled visits?
Everyone’s goals when starting treatment may be a little different. In general, the aim in treating MS is to:
- reduce the number of relapses
- prevent the damage that causes lesions in the brain and spinal cord
- slow the progression of the disease
It’s important to understand what your treatment can and can’t do, and to be realistic about your goals. Disease-modifying drugs can help reduce relapses, but they don’t prevent them entirely. You may need to take other medications to relieve symptoms when they occur.
Disease-modifying drugs can help slow the formation of new lesions in your brain and spinal cord, and they can help reduce relapses. It’s important to start on one of these treatments as soon as possible after diagnosis, and to keep up with your treatment for as long as your doctor recommends.
Disease-modifying MS treatments are available as injections, infusions, and pills.
- Beta-interferons (Avonex, Betaseron, Extavia, Plegridy, Rebif): You can take these types of medications as often as every other day or as little as every 14 days, depending on your treatment prescription. Side effects can include flu-like symptoms and injection site reactions, such as swelling, redness or discoloration, and pain.
- Glatiramer acetate (Copaxone, Glatopa, and generic equivalent): You can take this medication as often as every day or up to three times each week, depending on your treatment prescription. Side effects can include injection site reactions.
- Ofatumumab (Kesimpta): Your doctor will have you take this once per week for the first 3 weeks, followed by once per month starting from the fourth week onward. Side effects may include upper respiratory tract infection, headache, and injection site reactions.
- Cladribine (Mavenclad): This is a tablet you get in two courses a year for 2 years. Each course involves 4- to 5-day cycles, given 1 month apart. Side effects can include respiratory infections, headaches, and low white blood cell counts.
- Dimethyl fumarate (Tecfidera and generic equivalent): This is an oral treatment that you start by taking a 120-milligram (mg) capsule twice per day for 1 week. After the first week of treatment, you’ll take a 240-mg capsule twice per day. Side effects may include flushing of the skin, nausea, diarrhea, and belly pain.
- Diroximel fumarate (Vumerity): The dosage for this medication starts with a 231-mg capsule twice per day for 1 week. Then you double the dose to 2 capsules twice per day. Side effects can include skin flushing, nausea, vomiting, diarrhea, and belly pain.
- Fingolimod (Gilenya): This medication comes as a capsule that you take once per day. Side effects can include headache, flu, diarrhea, and back or belly pain.
- Siponimod (Mayzent): Under your doctor’s guidance, you take this medication by gradually increasing doses over the course of 4 to 5 days. From there, you’ll take a maintenance dose once a day. Side effects may include headaches, high blood pressure, and liver problems.
- Teriflunomide (Aubagio): This is a once-daily pill, with side effects that may include headaches, hair thinning, diarrhea, and nausea.
- Zeposia (Ozanimod): This is a once-daily pill, with side effects that can include increased risk of infection and a slower than usual heart rate.
- Monomethyl fumarate (Bafiertam): The dose for this medication is 95 mg twice per day for 1 week. After the first week of treatment, the recommended dosage increases to 190 mg twice per day. Common side effects include stomach pain, diarrhea, nausea, and flushing.
- Ponesimod (Ponvory): This is an oral treatment that you take once per day. You start by taking 2 mg per day, and the dosage gradually increases to a maintenance dose of 20 mg by day 15. Side effects include respiratory tract infections, high blood pressure, and liver problems.
- Alemtuzumab (Campath, Lemtrada): This comes as an infusion that you get once per day for 5 days in a row. One year later, you get three doses 3 days in a row. Side effects can include rash, headaches, fever, stuffy nose, nausea, urinary tract infection, and fatigue. You won’t typically get a prescription for this medication until you try two other MS drugs and find that they are ineffective for you.
- Ocrelizumab (Ocrevus): Your doctor will give this medication to you as a first dose, a second dose 2 weeks later, then once every 6 months. Side effects can include infusion reactions, an increased risk of infections, and a possible increased risk of some types of cancers, including breast cancer.
- Mitoxantrone (Novantrone): Healthcare professionals give you this medication once every 3 months, with a maximum of 12 doses in a 2- to 3-year period. Side effects can include nausea, hair loss, upper respiratory infection, urinary tract infection, mouth sores, irregular heart rate, diarrhea, and back pain. Due to these severe side effects, doctors usually reserve this drug for people with severe RRMS that worsens.
- Natalizumab (Tysabri): Doctors administer this treatment once every 28 days in an infusion facility. In addition to side effects like headaches, fatigue, joint pain, and infections, Tysabri may increase the risk of a rare and possibly serious brain infection called progressive multifocal leukoencephalopathy.
You will work together with a doctor to develop a treatment plan based on the severity of your disease, your preferences, and other factors. The American Academy of Neurology recommends Lemtrada, Gilenya, or Tysabri for people who experience a lot of severe relapses called “highly active disease.”
If you do develop side effects, call a doctor for advice. It’s important that you do not stop taking the drug without a doctor’s approval. Stopping your medication could lead to more relapses and nervous system damage.
Today, there are many different medications available to treat MS. Starting one of these drugs soon after a diagnosis can help slow the progression of your MS and reduce the number of relapses you get.
It’s important to be an active participant in your own care. Learn as much as you can about your treatment options so you can have a thoughtful discussion with a doctor.
Make sure that you know the potential benefits and risks of each drug. Ask what to do if the treatment you take doesn’t help, or if it causes side effects that you can’t tolerate.