The Importance of Disease Modifying Therapies for Multiple Sclerosis
MSAA’s Ultimate MS Treatment Guide
to learn about and compare all of the FDA-approved MS treatments.
Treatment with a disease-modifying therapy (DMT) is crucial for most patients with MS, since disease activity and damage continues within the CNS even when no new symptoms are present. When a patient begins a treatment regimen early in his or her disease course, disease activity is slowed. This not only reduces the number and severity of symptom flare-ups, as well as delays the progression of the disease (and possibly delays any related disability), but also reduces the number of active lesions that appear on an MRI.
A 21-year prospective study of individuals (with relapsing-remitting MS) who began therapy early in the disease found that they experienced a longer lifespan than those who did not begin treatment as early. Of those who didn’t start treatment early, MS-related pulmonary infection was the most common cause of mortality over the 21-year period.
Since 1993, more than 25 brand-name and generic DMTs have been approved and are available through prescription. Of these approved medications, all are approved for relapsing forms of MS (RMS), which includes secondary-progressive MS with relapses (active SPMS). Most of the treatments are also approved for clinically isolated syndrome (CIS), while currently, only one DMT, Ocrevus® (ocrelizumab), is approved to treat primary-progressive MS (PPMS).
Additionally, Gilenya® (fingolimod) and Ocrevus are the only DMTs that are also approved for the treatment of children and adolescents, ages 10 through 17, with relapsing forms of MS. Young people under the age of 18 who are diagnosed with MS are referred to having “pediatric MS”; the vast majority (98 percent) of individuals with pediatric MS are diagnosed with the relapsing form of the disease. Research (including many clinical trials) is ongoing at a rigorous pace to find additional treatments for all forms of MS.
FDA-Approved Disease-Modifying Therapies for MS (brand names listed)
Given via self-injection:
- Avonex® (interferon beta-1a)
- Betaseron® (interferon beta-1b)
- Copaxone® (glatiramer acetate injection)
- Kesimpta® (ofatumumab)
- Plegridy® (peginterferon beta-1a)
- Rebif® (interferon beta-1a)
Given via intravenous (IV) infusion:
- Briumvi® (ublituximab-xiiy)
- Lemtrada® (alemtuzumab
- Novantrone® (mitoxantrone)*
- Ocrevus® (ocrelizumab)
- Tysabri® (natalizumab)
Taken orally:
- Aubagio® (oral teriflunomide)
- Bafiertam® (monomethyl fumarate)
- Gilenya® (fingolimod)
- Mavenclad® (cladribine)
- Mayzent® (siponimod)
- Ponvory® (ponesimod)
- Tecfidera® (dimethyl fumarate or DMF, formerly known as BG-12)
- Vumerity® (diroximel fumarate)
- Zeposia® (ozanimod)
Getting early treatment and staying on one of the DMTs for MS may also delay the rate of conversion from RRMS to secondary-progressive MS (SPMS). As noted earlier, this form of MS that follows RRMS exhibits a steady worsening, with or without relapses (or flare-ups). If flare-ups do occur, they usually do not remit fully. As mentioned in the previous section, without treatment, approximately half of individuals with RRMS convert to SPMS within 10 years. However, with the introduction of more than 25 brand-name and generic DMTs since the first treatment became available in 1993, those taking a DMT experience a reduced or delayed conversion rate.
*In 2000, Novantrone® (mitoxantrone), given via IV infusion, was approved for RRMS, SPMS, and worsening RRMS. However, side effects may include cardiac disease and leukemia, and for this reason, is seldom prescribed for individuals with MS.
For more information on treatments for MS and how to select the treatment that is right for you, please see MSAA’s Ultimate MS Treatment Guide.