Disease-Modifying Medications for MS

The FDA has approved 14 disease-modifying medications for use in relapsing forms of multiple sclerosis (MS), which includes relapsing-remitting MS (RRMS), as well as progressive forms of MS in those who experience relapses.

According to the National MS Society, approximately 85% of MS patients are initially diagnosed with RRMS, which is characterized by clearly defined attacks of new or increasing neurologic symptoms. Although those symptoms differ greatly from patient to patient, they may include visual disturbances, muscle spasms and spasticity, neuropathic pain, musculoskeletal pain, fatigue, and behavioral problems like depression and anxiety. These relapses are followed by periods of partial or complete recovery, called remissions.

Here are FDA-approved disease-modifying medications for MS:

Avonex (interferon beta-1a)

This member of the interferon family has been around for many years and is one of the chief RRMS treatments. It slows the progression of MS and reduces the number and size of brain lesions, as well as the severity of disease relapse when it occurs.

Injections are given weekly and side effects are usually manageable. It’s not uncommon for those receiving an interferon injection to experience injection site reactions and flu-like symptoms (headache, chills, fever) within a few hours of the injection. Some serious side effects of this medicine include liver damage, seizures, and depression.

Rebif (interferon beta-1a)

This drug is very similar to Avonex. In a comparison study, patients taking Rebif experienced fewer relapses and new or enlarging brain lesions than those taking Avonex, although side effects were generally similar.

Rebif Rebidose is a preassembled, prefilled, single-use auto-injector. Rebif is also available in a prefilled syringe, with or without the reusable Rebiject II auto-injector.

Plegridy (peginterferon beta-1a)

This is a modified form of interferon that enables interferon molecules to maintain their biologic effects in the body for longer periods of time, which allows for less frequent dosing intervals. It’s administered by subcutaneous injection once every 14 days. Flu-like symptoms are the most common side effects, as well as pain and tenderness at the site of injection.

Betaseron and Extavia (interferon beta-1b)

These members of the interferon family have similar side effect profiles as the interferon beta-1a medications.

Copaxone (glatiramer acetate)

This is approved to reduce the frequency of relapses in patients with RRMS, preventing the body’s immune system from destroying the myelin that protects nerves. It’s also approved for use in individuals who’ve experienced a first clinical episode and have MRI features consistent with MS. Copaxone is administered subcutaneously once-daily (20 mg) or 3 times a week (40 mg). Common adverse effects include reactions at the injection site, heart palpitations, chest pain, and flushing.

Glatopa is the generic equivalent of Copaxone 20 mg, though it isn’t considered substitutable for Copaxone 40 mg.

Zinbryta (daclizumab)

The only once-monthly subcutaneous injection for relapsing MS is generally reserved for individuals who’ve had an inadequate response to 2 or more disease-modifying therapies (DMTs). Because of the risk of serious liver problems (including autoimmune-related liver problems) and other immune system problems, Zinbryta is only available through its restricted Risk Evaluation and Mitigation Strategy (REMS) Program.

Aubagio (teriflunomide)

This pyrimidine synthesis inhibitor is a once-daily oral tablet believed to work by blocking the reproduction of overactive immune cells (including T- and B-cells) that attack and damage the nerves in the central nervous system (CNS). It has been approved to treat relapsing forms of MS.

Gilenya (fingolimod)

This was the first oral MS medication approved by the FDA. Available as a once-daily tablet, Gilenya is part of a new drug class called a sphingosine 1-phosphate receptor modulators, which are thought to act by retaining certain white blood cells (lymphocytes) in the lymph nodes, thereby preventing those cells from crossing the blood-brain barrier into the CNS. Preventing the entry of these cells into the CNS reduces inflammatory damage to nerve cells.

According to the manufacturer, those taking Gilenya in a 1-year study had 52% fewer MS relapses than those taking Avonex, and in a 2-year study, those taking Gilenya had 54% fewer relapses than those taking placebo. Common adverse effects include increased risk of infection, increased risk of cardiac event (such as heart palpitations) following an injection, and eye toxicity.

Tecfidera (dimethyl fumarate)

This oral medicine is thought to constrain immune cells and prevent them from attacking the body’s nervous system. It may also act as an antioxidant and protect the brain and spine against further MS-related damage. Adverse effects include headache, flushing, and nausea.

Lemtrada (alemtuzumab)

This is thought to work by recognizing and removing certain immune cells believed to cause MS. It’s generally reserved for individuals who’ve had an inadequate response to 2 or more DMTs. Because of risks of autoimmunity, infusion reactions, and some kinds of cancers, Lemtrada is only available through its restricted REMS program.

Novantrone (mitoxantrone)

This acts in MS by suppressing the activity of T cells, B cells, and macrophages thought to lead the attack on the myelin sheath. It’s been shown to cause heart damage and possibly leukemia in some patients, and it’s generally prescribed to patients who haven’t responded to other treatments.

Tysabri (natalizumab)

This is designed to prevent immune cells from traveling from the bloodstream into the brain and spinal cord. Research has shown it can reduce the number and severity of MS relapses, though it has also been shown to increase the risk of progressive multifocal leukoencephalopathy, a rare but potentially fatal brain infection. Less serious adverse effects include headache, fatigue, joint pain, and allergic reactions.

Treatment with any DMT should be continued indefinitely unless it isn’t controlling the disease adequately, in which case switching to another DMT should be considered. Making a switch to another DMT is also advised if adverse effects become intolerable or the patient’s unable to follow the recommended regimen.

Research into newer and better DMTs is a rapidly developing area that brings hope for better outcomes for MS patients.