Treatment Options for Multiple Sclerosis

What Is Multiple Sclerosis?

Multiple sclerosis (MS) is a debilitating autoimmune disorder that causes an assault on the central nervous system. The resulting inflammation destroys the myelin sheath, the fatty substance that insulates and protects nerve fibers. For some, the disease is progressive, while others have episodes of symptom flares. 

The resulting neurological symptoms of MS are relevant to where the nerve damage occurs. The areas attacked by the immune system develop multiple areas of scar tissue. This results in unpredictable symptoms. There are four types of MS. Those four types include:

  • Relapsing-Remitting (RRMS) – symptoms flare and subside. About 85 percent of those diagnosed have RRMS
  • Secondary-Progressive (SPMS) – symptoms steadily worsen over time, with or without periods of remission
  • Primary- Progressive (PPMS) – symptoms continually worsen without periods of remission. Approximately ten percent of MS patients have PPMS
  • Progressive-Relapsing (PRMS) – the disease steadily worsens with acute relapses but no remission. This rare form of MS is diagnosed in 5 percent of all cases

Methods for Treating MS

Currently, there’s no cure for MS. There are treatment options available to reduce the incidence of disease flares and minimize the progression of this potentially debilitating condition. To learn more about these medications, or other treatment options, you are advised to consult with your healthcare provider.

Researchers suspect that MS has genetic components, triggered by environmental factors. The goal of MS treatment is to reduce inflammation, disease activity, and the level of disability resulting from the disease. In recent years, the FDA has approved several new medications to treat MS.

Tecfidera (dimethyl fumarate)

Tecfidera gained FDA approval in March 2013 as a new first-line oral treatment for relapsing forms of MS. Tecfidera activates the Nrf2 pathway, providing a way for healthy cells to defend against inflammation and oxidative stressors. Tecfidera is shown to reduce the activity of MS and slow the development of lesions on the brain. This medication is prescribed in pill form and typically taken twice per day.

Rebif (interferon beta-1a)

Rebif was approved in March 2002 to treat the relapsing forms of MS. Rebif is dispensed as a pre-filled syringe and was approved for use in European countries in 1998. This medication is currently registered for use in 70 countries. It is typically injected 3-4 times per week.

This disease-modifying treatment is derived from human proteins and used to supplement naturally occurring interferon in the body. Rebif decreases the levels of several pro-inflammatory cytokines. Rebif is prescribed to slow the progression of relapsing MS and reduce the number of relapses. 

Tysabri (natalizumab)

Approved by the FDA in June 2006, Tysabri is also prescribed for patients with relapsing forms of MS. Tysabri is prescribed to reduce the frequency of relapses. The medication is administered in the form of an intravenous (IV) infusion, typically 300 mg every four weeks, for treatment of acute MS relapses.

Tysabri works by blocking integrin molecules and preventing immune cells from migrating throughout blood vessels to areas of inflammation. This results in a reduction of leukocyte migration into parenchyma in the brain and a reduction in plaque formation. 

Plegridy (peginterferon beta-1a) 

The FDA approved Plegridy as a new treatment for relapsing forms of MS in August 2014. Plegridy can be injected below the skin and is typically prescribed bi-weekly. This medication is available in a pre-filled syringe or as an autoinjector. Dosages are increased gradually towards the recommended 125 micrograms on the 29th day of treatment. 

The active ingredients in Plegridy (peginterferon beta-1a) appears to work by enhancing the production of interferon beta-1a, calming the overactive immune system response. Plegridy is shown to be effective in reducing the number of relapses, delaying the progression of physical disability, and reducing the number of brain lesions visible on MRI scans.

Avonex (interferon beta-1a)

Approved by the Food and Drug Administration in May 1996, Avonex was heralded as the first genetically engineered medication shown to slow the progression of relapsing MS. A previous medication (Betaseron) reduced the frequency and severity of relapses but did not slow the progression of the disease.

Avonex is shown to help the body fight viral infections, slow disease progression, and decrease flare-up symptoms such as balance disruption, weakness, and numbness. Avonex is typically injected into the muscles of the thigh or upper arm.

Gilenya (fingolimod) 

This sphingosine 1-phosphate receptor modulator was approved by the FDA in September 2010 for the treatment of relapsing MS. Gilenya is prescribed in capsule form as an oral medication taken once daily. Gilenya is believed to reduce the frequency of relapses and delay the onset of physical disability. 

This medication inhibits the ability of lymphocytes (infection-fighting white blood cells) to leave the lymph nodes, reducing the number of lymphocytes in the bloodstream and reducing the amount of lymphocyte migration to the central nervous system.

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