Relapsing-remitting multiple sclerosis (RRMS) treatment has come a long way in recent years. Combining drug therapy with natural and alternative treatments can help manage symptoms, reduce the number of relapses, and slow disease progression.
Understanding your options can help you and your doctor choose the treatment that’s right for you.
Currently, there are 12 medications approved by the Food and Drug Administration (FDA) for treating RRMS. Some of these medications are specifically for the treatment of advanced RRMS that hasn’t responded to other treatments. They include:
- Aubagio (teriflunomide): This drug is taken daily by mouth for the treatment of relapsing forms of MS.
- Avonex (interferon beta-1a): Avonex prevents the immune system from attacking the central nervous system, reducing the frequency and severity of attacks. It’s injected into the muscle once a week or under the skin three times a week for the treatment of RRMS.
- Betaseron (interferon beta-1b): This medication is made from human blood plasma and given by injection under the skin every other day to reduce the number and severity of relapses and inflammation.
- Copaxone (glatiramer acetate): This biological drug is made from four different proteins. Copaxone can be given daily or at a higher dose every three days via an injection under the skin.
- Extavia (interferon beta-1b): This drug is given every other day via injection under the skin to reduce symptoms and the number of RRMS attacks.
- Gilenya (fingolimod): Taken orally every day, Gilenya works to reduce the number of attacks and delay disability.
- Lemtrada (alemtuzumab): The FDA recommends that this medication be reserved for those who haven’t had a good response to one or two other drugs. It’s given intravenously for five consecutive days for one year and then three consecutive days beyond that.
- Novantrone (mitoxantrone): Commonly used to treat cancer, Novatrone is given intravenously four times a year under the supervision of a doctor. The National MS Society advises not to exceed eight to 12 doses over two to three years. It is used for those with worsening RRMS symptoms that have been resistant to other treatments.
- Plegridy (pegylated interferon beta-1a): Unlike other interferons, Plegridy stays active in the body for longer periods. It’s given every two weeks to reduce relapses and brain lesions and delay physical disability.
- Rebif (interferon beta-1a): This drug is given by injection under the skin three times a week and works similarly to Avonex.
- Tecfidera (dimethyl fumarate): Approved for treatment of RRMS in 2013 and formerly known as BG-12, Tecfidera is taken orally twice a day in 120 mg capsules for one week and 240 mg beyond that.
- Tysabri (natalizumab): According to the National MS Society, this drug shouldn’t be used in combination with any of the other disease-modifying drugs (DMDs) for MS. It’s recommended for those who’ve not seen improvement with other medications. Ask your doctor about a referral because it requires special administration procedures.
Medications to treat the symptoms of RRMS
Other medications are available to help you get relief from the symptoms of RRMS. Your doctor can prescribe a muscle relaxant to help with stiffness and spasms. There are also medications available to treat fatigue, pain, sexual dysfunction, as well as bladder and bowel issues.
While medications used to treat RRMS can be effective at managing the symptoms and/or progression of the disease, they can also bring about unwanted side effects.
Examples of medications used to treat RRMS and their common side effects include:
- Injectable MS drugs can cause flu-like symptoms of muscle and joint pain, chills, and fever. These side effects can happen within a few minutes to a few hours after the injection. They can also cause a permanent dent in the skin.
- Some treatments for RRMS can cause mood disorders, changes in a woman’s menstrual cycle, and liver damage. All of this will need to be monitored.
- Any treatments given by shot or IV can cause redness and skin irritation at the site of the injection.
- Some medications can contribute to brain fog, confusion, and headaches.
- Oral medications are available to treat MS, but you can’t use them if you’re pregnant or planning to become pregnant. Many have side effects like nausea, stomach pain, and/or diarrhea.
Most side effects do not indicate a serious problem, but consult your doctor if side effects are severe or disruptive. There are a variety of medications, and you’ll likely be able to try another to see what works best for you.
Although treatment with an FDA-approved DMD is recommended, there are complementary lifestyle treatments that you can use alongside medication to help manage the symptoms of RRMS.
Complementary treatments for RRMS should not be used as replacements for your doctor’s recommended treatment plan. They are often used to help manage side effects of treatment. Make sure to talk to your doctor before trying any complementary treatments.
Diet and nutrition
Diet and nutrition is an important part of overall health, and can help contribute to treating both RRMS and side effects caused by the medications.
Some foods to add to your diet include:
- olive oil
- fruits and vegetables
- nuts and seeds
- oily fish
Foods to avoid include:
- processed foods
- excessively salty foods
- dairy products
- saturated fats
Some vitamins and supplements that can help treat RMSS include:
- omega-3 fatty acids
- Ginkgo biloba, which can help lessen tiredness
- vitamin D
- vitamin A
- vitamin B-12
A physical therapist can teach you different exercises to help stretch and strengthen muscles, which may reduce pain and make it easier for you to perform your daily activities. MS can cause muscle weakness, so it’s important to try to maintain strength.
Various studies have found that exercise can improve walking mobility in those with MS. Exercise can also improve cardiovascular function and strength, bladder and bowel function, combat fatigue, and fight depression. Walking, yoga, and adaptive tai chi are just a few types of exercise recommended for those with RRMS.
Although there’s no current evidence to suggest that acupuncture can reduce the number of attacks or slow disease progression, the National MS Society suggests that it may provide relief for some of the symptoms of MS, including:
- bladder issues
Steroids are sometimes used to treat RRMS, and they can be administered orally, via injection, or intravenously. Because symptom flares of RRMS are a result of the brain and spinal cord becoming inflamed, using steroids to reduce inflammation can help lessen symptoms and treat relapses.
While steroids can be effective and have several benefits, they can also have some disadvantages and negative side effects. You and your doctor should weigh the pros and cons carefully.
Pros of steroid treatments for RMSS treatment include:
- therapeutic benefits in treating relapses of RMSS
- they may reduce tissue damage (though this is still being studied)
- steroids can be more cost-effective than some other medications
Potential cons of using steroids to treat RMSS include:
- gastrointestinal distress
- repeat usage can suppress the immune system, increasing the odds of future infections
- exacerbations of preexisting diabetes or hypertension
- steroids can only be used in short courses, so they’re not a regular (or permanent) solution
As with other chronic conditions, the cost of treatments for RRMS can add up quickly. Because of this, it’s good to know what the treatments can cost. Exact costs will depend on your specific insurance plan, and your doctor or local pharmacy can advise you on costs of generic drugs versus name brands.
One study suggested that IFN Beta-1a SC injections, IFN Beta-1b SC injections, and glatiramer acetate are the most cost-effective treatments for RRMS, as assessed with the cost-effectiveness taking into the account the cost per relapse.
There are a large variety of treatments available for RRMS, its progression, and its symptoms. These treatments include prescription medications, complementary treatments and lifestyle changes, physical therapy, and acupuncture. If one treatment doesn’t work for you, you can try a new combination of available treatments to see what will.
Consult your doctor before adding anything new to your treatment plan. Even natural supplements can have dangerous interactions with the drugs you’re taking, or may not be ideal based on other medication conditions. Make sure to bring any concerning side effects to your doctor’s attention as well.