Most people who are diagnosed with multiple sclerosis initially have the relapsing-remitting form (RRMS). Over time, this can change.

In most cases, RRMS will eventually become secondary progressive MS (SPMS). RRMS causes alternating periods of symptoms, or relapses, and symptom-free periods called remission. In SPMS, damage to the brain and spinal cord progresses gradually over time, without remission.

Some people have the “active” form of SPMS. The disease progresses over time, but they also continue to have periods of low disease activity and relapses.

Disease-modifying therapies (DMTs) are drugs that slow MS progression, reduce the number of relapses, and help prevent brain and spinal cord damage. Until a few years ago, most DMTs only worked in people with RRMS. That’s changed, with the approval of a few new drugs designed to treat SPMS, too.

Three different DMTs are FDA-approved specifically to treat types of SPMS.

Siponimod (Mayzent)

In 2019, the FDA approved siponimod (Mayzent) to treat relapsing forms of MS, including RRMS and active SPMS. The treatment is given as a pill that’s taken orally once a day. Studies show that it slows MS progression and reduces the number of relapses.

Because this drug acts on the cells of the immune system, it could increase the risk for infection. Your doctor may want to check your blood cell count before you start taking it. If you are pregnant or planning to become pregnant, you should not use siponimod.

The most common side effects from siponimod include headache and high blood pressure. Other possible risks with this medication are:

  • inflammation in the macula of the eye, called macular edema
  • vision changes
  • slowed heart rate
  • lung problems
  • liver damage
  • birth defects

Cladribine (Mavenclad)

Shortly after approving siponimod, the FDA also approved cladribine (Mavenclad) to treat relapsing forms of MS, including active SPMS.

This medication is a pill that’s taken on a specific schedule. The pill is taken in two treatment cycles over a period of two years. Each cycle lasts for up to 20 days.

In studies, cladribine reduced the number of relapses and slowed MS progression.

Your doctor may recommend this drug only if other MS medications haven’t worked for you, because of its risks. It has a black box warning — the strongest warning a medication can carry about its possible side effects — because it may increase the risk of cancer and birth defects.

Before starting this treatment, talk to your doctor about whether you’re at increased risk for cancer or you’ve had cancer in the past.

Both women and men who are sexually active and fertile, and who could potentially conceive a baby with their partner, need to use contraceptives if they take cladribine. If a person becomes pregnant, they should stop taking it right away.

Other risks related to this medication are:

  • an increased risk for colds, shingles, and other infections
  • headaches
  • low white blood cell count and other blood cell counts
  • liver damage

Mitoxantrone (Novantrone)

Mitoxantrone was originally a cancer medication. It’s been FDA-approved for treating certain types of MS, including SPMS.

In someone with MS, the medication stops immune cells from attacking the myelin sheath that protects nerves. It may help reduce disability in people with SPMS.

Mitoxantrone comes as an infusion that’s given once every three months.

Side effects include an increased risk for congestive heart failure. Your doctor may check your heart health before you start taking this drug. It’s not recommended for use during pregnancy.

If you’re living with active SPMS, the National MS Society notes that you may be able to try one of the many DMTs that are FDA-approved to treat relapsing forms of MS. The following medications may reduce how often you experience relapses:

  • alemtuzumab (Lemtrada)
  • dimethyl fumarate (Tecfidera)
  • fingolimod (Gilenya)
  • glatiramer acetate (Copaxone)
  • interferon beta-1a (Avonex, Rebif)
  • interferon beta-1b (Betaseron, Extavia)
  • natalizumab (Tysabri)
  • ocrelizumab (Ocrevus)
  • teriflunomide (Aubagio)

Some treatments for SPMS target specific symptoms. These medications won’t generally slow the progression of the disease, but they may help you feel better and improve your quality of life.

Some medications may help with relapses, if you have them, including methotrexate and corticosteroids. Your doctor can also prescribe treatments for specific symptoms, such as:

  • amantadine (Gocovri, Oxmolex), modafinil (Provigil), and methylphenidate (Ritalin) to relieve tiredness
  • citalopram (Celexa), fluoxetine (Prozac), and sertraline (Zoloft) to treat depression
  • dalfampridine (Ampyra) to improve walking ability
  • duloxetine (Cymbalta), gabapentin (Neurontin), and venlafaxine (Effexor) to ease pain
  • muscle relaxants to relieve muscle stiffness and spasms
  • oxybutynin (Oxytrol), tamsulosin (Flomax), and tolterodine (Detrol) to treat bladder problems

Medication isn’t the only way to manage SPMS. Lifestyle changes can be helpful, too.

Exercise and physical therapy may help improve your mobility and reduce pain. Time management strategies can help you avoid fatigue. And cooling devices can help prevent you from feeling too hot.

SPMS can be managed with medications. These treatments may focus on modifying the course of the disease or treating specific symptoms.

Newly approved medications for SPMS have made it easier to slow the disease, especially for people who continue to have relapses. Lifestyle changes may also make a difference.

Your doctor can advise you about your treatment options and provide more information about new medications. Discuss the possible benefits, as well as the risks, before you decide on a treatment.