Treatment for MS

In MS, there are different areas of treatment for controlling the symptoms, quieting acute relapses, and slowing the progress of the disease. However, most often when people speak about treatments, they are referring to disease-modifying treatments – medications designed to specifically slow the disease progression. 

The need for disease-modifying treatment

The goal of disease-modifying treatment is to minimize the damage MS does inside a person's central nervous system. Early in the disease, new areas of inflammation occur more frequently than new symptoms. So even when a person is not experiencing new symptoms, silently MS can be growing worse. The available treatments cannot reverse or halt the disease, but they can slow it down. The slower the disease progresses, the less damage accumulates. Ideally, this means a person will have fewer relapses, fewer symptoms, and face less disability over time than they would have without treatment. For this reason, it is recommended that treatment begins as early as possible. 

When symptoms don't improve with this kind of treatment, sometimes people assume the medication isn't working. However, it's important to remember that the goal of disease-modifying treatment is to keep the disease from progressing. A disease-modifying treatment may or may not make a person feel better; hopefully, it prevents them from getting worse.

Approved disease-modifying treatments

There are more than a dozen disease-modifying treatments approved for use in MS.  Some are injections, others are pills, or even intravenous infusions. Depending on the treatment, they may be taken daily, weekly, monthly, or even yearly.

Many people wonder, "Why so many? Why not just prescribe the one that is the most effective?"

The process of finding the "most effective" treatment can be as unpredictable as the disease itself. Each person’s MS may respond differently, and there is currently no means to predict which treatment will be the best option for a particular person. At times, people with MS may have to try several treatments to find one that works well for them. 

A person diagnosed with MS should expect to be involved in the decision-making about their treatment. With other conditions, a doctor will often simply write a prescription for the medication they believe is most appropriate. With MS, selecting a treatment depends on a number of factors. These may include the severity of disease, tolerance for risk of potential complications, other health conditions, and personal preference about how, when, and where the medication is taken.

MS medications are sometimes described as first, second, or third line. This indicates whether the drug is usually prescribed as a first option, or something to try after other medications have failed to help a person’s condition. Some MS drugs have potential for complications that can be quite serious, and even life-threatening. These medications may require monitoring under an FDA Risk Evaluation and Mitigation Strategy. As a general rule, those drugs with higher risk profiles are considered second or third line drugs. However, that decision is at the discretion of the doctor and person receiving treatment, and perhaps influenced by insurance company requirements.

Remember,  the selection of a treatment for MS is a complex one. Depending upon individual circumstances, those medications typically considered second line treatments may be recommended as a first choice on occasion. The following chart only indicates their common use. Discuss the factors involved in selecting your treatment with your healthcare provider.

Brand
Mediation
Type
Frequency
Approved For
Has special FDA monitoring plan
Approved generic equivalent
Typically used as
Aubagio
teriflunomide
Pill
once daily
Relapsing forms of MS
First Line
Avonex
interferon beta-1a
Injection
weekly
Relapsing forms of MS
First Line
Betaseron
interferon beta-1b
Injection
every other day
Relapsing forms of MS
Extavia
First Line
Copaxone
glatiramer acetate
Injection
daily (20 mg) or three times per week (40 mg)
Relapsing forms of MS
Glatopa
First Line
Gilenya
fingolimod
Pill
once daily
Relapsing forms of MS
Yes
Second Line
Lemtrada
alemtuzumab
Infusion
5 consecutive days, then 3 days twelve months later
Relapsing forms of MS
Yes
Second or third line
Novantrone
mitoxantrone
Infusion
every three months
Progressive or worsening MS
Third Line
Ocrevus
ocrelizumab
Infusion
every six months
Progressive or worsening MS
First line
Ocrevus
ocrelizumab
Infusion
Every six months
Relapsing forms of MS
First or Second line
Plegridy
peginterferon beta-1a
Injection
every two weeks
Relapsing forms of MS
First Line
Rebif
interferon beta-1a
Injection
three times per week
Relapsing forms of MS
First Line
Tecfidera
dimethyl furnarate
Pill
twice daily
Relapsing forms of MS
First Line
Tysabri
natalizumab
Infusion
every four weeks
Relapsing forms of MS
Yes
Second Line
Zinbryta
daclizumab
Injection
monthly
Relapsing forms of MS
Yes
Second Line

 

MS Focus does not recommend any particular medication or treatment. 

"Natural" treatment

Many people wonder if medications are necessary. They may be concerned about potential side effects, or question whether there are natural treatments that might be just as effective. While several alternative therapies have been shown to relieve symptoms or improve quality of life, none have yet proven to be effective in acting upon the disease itself. It is recommended that alternative treatments be used together with drug treatment for optimal results. Learn more at Alternative Treatments.