Disease-Modifying Therapies for the Treatment of MS
Disease-modifying therapies (DMTs) were originally developed for relapsing-remitting MS (RRMS), as this type of MS responded more readily to treatments and study results were easier to measure compared to secondary-progressive MS (SPMS) and primary-progressive MS (PPMS). As researchers learned more about treating these latter forms of the disease, individuals with SPMS and PPMS were able to participate more frequently in clinical trials. As a result, some treatments are now approved to treat these progressive forms of MS.
The first DMT was approved by the United States Food and Drug Administration (FDA) in 1993. Since that time, more than two dozen DMT types and brands have been approved – and the number continues to grow. Following the initial DMTs given via self-injection, the next DMTs to be approved were those given by intravenous (IV) infusion, and eventually, oral medications became available.
Although differences exist in study design and specific findings, trials generally show these common results:
- Reduced the number of relapses
- Reduced the severity of relapses
- Reduced the development of new areas of inflammation as seen on magnetic resonance imaging (MRI) scans
- Showed some evidence of delaying disease progression and/or disability
- Some may prevent or delay a second clinical attack (relapse) for individuals with clinically isolated syndrome (CIS). CIS refers to individuals who do not meet the criteria to be diagnosed with MS, but have experienced symptoms.
The documented effectiveness of each of these medications varies to some extent, and differences can be attributed to the type of drug, dose and administration, as well as variations in study design. Stronger medications may offer greater effectiveness, but may also pose greater health risks.
Additionally, the effectiveness and side effects of each medication may vary from one patient to another, so individuals need to work closely with their physician to determine which treatment might be the best option. Once taking a DMT, the patient will continue to be evaluated to determine how well the treatment is working and if the side effects are reasonable. If needed, patients may try a different DMT with the goal of achieving an optimal response while experiencing the fewest side effects.
As noted earlier, MS is an autoimmune disease, where one’s immune system becomes misdirected and attacks the body’s myelin (the protective covering of the nerves) and eventually the axons (nerves of the central nervous system, or CNS). This misdirection of the immune system involves a cascade of events leading to the damage caused by MS, and each of the approved DMTs are designed to interfere in some way with this cascade of events – with the goal of slowing the damage to the CNS.
For complete information on all of the approved DMTs for MS, how they are administered, how they work, and what side effects may occur, please visit MSAA’s Ultimate MS Treatment Guide at MStreatmentguide.org
Featuring videos of experts and advocates discussing treatment information and experiences, as well as charts to easily compare the different DMTs, this unique online tool can help individuals with MS and their care partners make an informed choice on treatment in conjunction with their physician.