Medication can help to reduce the number of relapses, with the hope of slowing the progression of multiple sclerosis, or MS. Using medications can also help you to manage attacks and reduce day-to-day symptoms.
In people with MS, central nervous system dysfunction is caused by an autoimmune reaction that destroys myelin—the fatty lining that surrounds and protects nerves in the brain and spinal cord. When myelin is damaged, scar tissue forms. This is called sclerosis, also known as lesions.
Lesions disrupt nerve impulses traveling to and from the brain and the rest of the body. This causes nerve impulses to be slowed or garbled, or they may even be halted altogether. This leads to the development of symptoms of MS.
The vast majority of people with MS—or those who’ve had an initial attack that is suggestive of MS, which is called clinically isolated syndrome—are prescribed medication to reduce the number of relapses and to slow the rate of new lesion formation.
Today, people have several medications to choose from. Although NYU Langone doctors always hope the first medication works well for you, many people need to try a few different medications before finding one that prevents relapses with as few side effects as possible. You and your doctor spend time discussing which medication may work best by considering how aggressive the disease is and your lifestyle as well as the side effects of the medication.
MS medications can be divided into three classes, depending on how they are taken: by injection, by mouth, and through an infusion.
Two types of injectable medications are often used as initial therapy. These include several interferon medications as well as Copaxone®.
The interferons Avonex®, Betaseron®, and Rebif® are very similar to each other but differ primarily in the dose and frequency with which they are taken. Avonex® is injected once a week directly into muscle. Betaseron® and Rebif® are injected more frequently under the skin.
A new interferon, Plegridy®, was approved by the U.S. Food and Drug Administration (FDA) in the summer of 2014. This medication is very similar to the other interferons, but is designed to be taken every other week.
Interferons can cause side effects, such as flu-like symptoms and injection site reactions. NYU Langone specialists perform blood tests to monitor white blood cell and liver enzyme levels as well as thyroid function while you are taking these medications.
Copaxone® is a daily injection under the skin. It can be given three times a week. The main side effect of this medication is irritation and lipoatrophy—the loss of fat tissue—at the injection site, which can develop with prolonged use of this medication.
Doctors may also prescribe medications that are taken by mouth to reduce the number of relapses. These include Tecfidera®, Gilenya®, and Aubagio®.
Tecfidera® is taken twice a day. Side effects may include upset stomach and red, flushed skin that feels hot. Blood tests are done to monitor your white blood cell levels while you are taking the medication.
Gilenya® is taken once a day. People using this medication need to have their heart rate monitored for six hours after the first dose, because the medication may cause a slower heartbeat in the first day after ingestion. Our specialists also perform an electrocardiogram, or EKG—a test that records the heart’s electrical activity—before you start taking this medication to establish typical cardiac function.
People taking Gilenya® also need an examination by an ophthalmologist prior to starting this medication and at least three months after treatment has begun to evaluate for a condition called macular edema, or fluid leakage, in the eye. This condition is reversible if caught in time. In addition, regular blood testing enables doctors to monitor your white blood cell and liver enzyme levels while taking this medication.
Aubagio® is also taken once daily. Monthly blood tests are required for the evaluation of liver enzyme levels during the first six months of treatment. Women of childbearing age should not take this medication, because of the potential for birth defects. These can occur up to two years after you stop taking the medication.
For people who have more severe MS or have not responded to other treatments, doctors may prescribe Tysabri® to block potentially damaging immune cells from entering the central nervous system. This is considered to be the most effective medication for reducing the number of relapses and new lesions detectable on an MRI scan. Tysabri® is given once a month through a vein with intravenous (IV) infusion.
Many people are prohibited from using this medication due to the risk of developing progressive multifocal leukoencephalopathy, a viral infection of the brain. This condition can develop in people who have previously been exposed to the JC virus. Your doctor uses a simple blood test to see if you have been exposed to this virus to help determine the risk associated with you being treated with this medication.
Lemtrada® was recently approved by the FDA. It is administered once a year as an IV infusion. This is a powerful medicine for people who have an aggressive form of MS. However, Lemtrada® is associated with a high risk of developing autoimmune diseases that affect thyroid function or blood platelet levels. Therefore, people need to be carefully monitored with monthly blood tests for the duration of therapy.
Novantrone® is the only medication currently approved for people with secondary-progressive MS. This immunosuppressant medication is delivered by IV infusion. Because Novantrone® can be harmful to the heart, people taking this medication require heart scans every few months, even years after they stop treatment. For this reason, there is also a lifetime maximum dose of this medication. The medication is also associated with the development of blood cancers. People taking it need regular monitoring through blood tests.
Medication management is an important part of treatment for people with all forms of MS. NYU Langone physicians work with you to control some of the side effects of these medications and to provide support along the way. Because it’s impossible to predict when MS symptoms might return, people with the condition follow up regularly with their care team on a long-term basis.
Doctors may prescribe high-dose IV corticosteroid infusion daily for three to five days during an MS flare up to shorten the attack by reducing nerve inflammation. Side effects may include upset stomach, increased blood pressure and blood sugar levels, insomnia, or mood swings. After this treatment, doctors may prescribe an oral corticosteroid, such as prednisone, to be taken for several days.
Another option for people who cannot tolerate steroids is a natural form of adrenocorticotropic hormone called H.P. Acthar® Gel. Adrenocorticotropic hormone stimulates the adrenal glands to make several different steroid hormones.
Doctors can inject H.P. Acthar® Gel into a muscle but typically teach you how to do so yourself. It is as effective as IV steroids, and its side effects are similar to those of steroids.