Introduction to Treatments for Multiple Sclerosis
Many effective medications are available for the treatment of multiple sclerosis (MS). These types of drugs may be prescribed for three different categories of MS treatment. The first area of treatment is to slow MS activity and progression; the second area is to reduce the severity and duration of a relapse; and the third area is to treat the symptoms of MS individually. All of these medications are prescribed by a physician – usually a neurologist who specializes in MS. Individuals considering a change to their present treatment regimen should always consult their physician.
Long-term treatments for MS are also referred to as disease-modifying therapies (DMTs). Presently, these include more than 20 approved brand-name and generic DMTs to slow MS activity and progression, each of which is approved by the United States Food and Drug Administration (FDA) for relapsing forms of MS in adults – and some are also approved for clinically isolated syndrome, prior to the diagnosis of MS. Newer approvals also include other forms of MS, as noted in the details to follow.
In 2017, Ocrevus™ (ocrelizumab) was approved for two types of MS: relapsing forms of MS (RMS) and primary-progressive MS (PPMS). In 2019, Mayzent® (siponimod) oral tablets, Mavenclad® (cladribine) oral tablets, and Vumerity™ (diroximel fumarate) oral capsules, were approved to treat RMS as well as active secondary-progressive MS (SPMS), which is a more steady form of MS that follows RRMS, but still has relapses. Mayzent and Vumerity are also approved for clinically isolated syndrome (CIS).These are the only DMTs to be approved in recent years for active SPMS. While both are approved for RMS and active SPMS, Mayzent is also approved for clinically isolated syndrome (CIS). Another DMT, Ocrevus™ (ocrelizumab), is the only DMT that is also approved for primary-progressive MS.
Additionally, Gilenya® (fingolimod), is the only DMT 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. In nearly all instances, these drugs are prescribed individually, so a patient only takes one DMT during any time period.
Of these 20-plus approved brand-name and generic medications, eight are given at home via injection; four are given by a medical professional via intravenous (IV) infusion; and nine* are taken orally.
*Please note that these nine oral medications include three approved generic versions of Gilenya® (fingolimod) capsules, which are not yet available.
Treating relapses helps to control the sudden flare-up of symptoms, also referred to as exacerbations or attacks. Relapses usually range in length from a few days to a few months before subsiding. While such treatments may be able to shorten the length of the relapse and lessen its severity, treating a relapse does not appear to affect the long-term progression of the disease or its symptoms.
Symptom management is another equally important area in the overall treatment of MS. Symptoms vary greatly from one individual to another, and each symptom needs to be addressed by healthcare professionals who specialize in MS. In addition to medications prescribed for a specific symptom, other treatment therapies – such as rehabilitation, counseling, and exercise, for example – may be recommended by the healthcare team to increase the effectiveness of managing certain symptoms.
Most of these medications are available by prescription only, but even with over-the-counter medications, anyone considering making a change to his or her present regimen should consult a physician. Some of the medications listed may cause side effects, and these can be managed by one’s medical professional through adjusting dosage, switching drugs, or adding other medications.
Women who are pregnant or planning to become pregnant need to discuss any medications they are taking and any new medications they are considering with their doctor. For more information on pregnancy and MS, as well as the different classifications of FDA drug warnings for pregnancy, please see “Women with MS.”
Please refer to MSAA’s listing of Prescription Assistance Programs for information on financial help with many of these medications.
The Multiple Sclerosis Association of America (MSAA) does not recommend or endorse any particular product, treatment, or medication. All information given is to increase awareness of the options available and should not be used to determine one’s treatment plan. Specific treatment decisions should only be made in conjunction with one’s neurologist and healthcare team.