Personalized therapy for multiple sclerosis (MS)
Find out about available and emerging treatment therapies for multiple sclerosis (MS).By Mayo Clinic Staff
Multiple sclerosis (MS) is a chronic inflammatory central nervous system disease that causes bothersome or disabling physical symptoms, including problems with mobility, vision, coordination, cognitive function, fatigue and pain.
If you've been diagnosed with relapsing-remitting MS, your doctor may recommend immediate treatment with medications known as disease-modifying therapy (DMT). DMTs have been shown to affect the course of MS by reducing the number of relapses and delaying progression of disability to some degree.
DMT also appears to prevent new MS-related lesions in the brain as shown by magnetic resonance imaging (MRI).
No approved therapies have been shown to effectively slow the progression of primary progressive MS.
Available DMTs differ in terms of how often they're taken, the method in which they're taken, their side effects and whether they can be taken during pregnancy. A thorough understanding of available and emerging DMTs can help you and your doctor form the best possible treatment strategy for your relapsing-remitting MS.
Currently, there are 14 Food and Drug Administration (FDA)-approved DMTs with varying degrees of effectiveness and risk in reducing relapses and preserving neurological function.
Interferon beta drugs. These medications are among the first DMTs approved for relapsing MS and are still commonly first line options for treatment. These first generation therapies include the following interferon beta medications:
- Avonex (interferon beta-1a)
- Betaseron (interferon beta-1b)
- Extavia (interferon beta-1b)
- Rebif (interferon beta-1a)
- Plegridy (peginterferon beta-1a)
Known as immunomodulatory drugs, the exact mode of action of these medications is unknown, but interferon beta is thought to target various immune cells and proteins that play an important role in the inflammatory activity of MS.
The interferon beta medications are given by self-injection, either under the skin or in the muscle. The frequency of injections varies from once every two weeks to three times weekly.
These drugs have comparable effectiveness, reducing the relapse rate by about one-third and slowing the development of new MS-related brain lesions for relapsing MS.
Flu-like symptoms and injection site reactions, such as redness and discomfort, are commonly reported side effects of interferon beta drugs.
Glatiramer acetate. Along with interferon beta drugs, glatiramer acetate (Copaxone and the generic version, Glatopa) is considered to be a first line treatment option for relapsing MS. Exactly how glatiramer acetate works is unknown, though it's thought to act through immune system cells known as T cells. It may also have potential nerve-protecting effects.
Glatiramer acetate is given by self-injection under the skin, either three times weekly or every day. It is generally well-tolerated, but injection site reactions, such as redness and discomfort, are commonly reported.
Ocrelizumab (Ocrevus). This humanized immunoglobulin antibody medication is the only DMT approved by the FDA to treat both the relapse-remitting and primary progressive forms of MS. Clinical trials showed it reduced relapse rate in relapsing disease and slowed worsening of disability in both forms of the disease.
Ocrevus is given via an intravenous infusion by a medical professional. Side effects may include infusion-related reactions, such as irritation at the injection site, low blood pressure, fever, and nausea among others. Ocrevus may also increase the risk of some types of cancer, particularly breast cancer.
Natalizumab (Tysabri) is a humanized monoclonal antibody that acts by reducing the migration of immune cells across the blood-brain barrier into the central nervous system. This medication is given intravenously every four weeks.
Natalizumab is effective against relapsing MS, reducing the relapse rate by about two-thirds. However, it is associated with a small but important risk of a serious brain infection known as progressive multifocal leukoencephalopathy (PML).
People who take natalizumab must be closely monitored for symptoms of PML, which include progressive weakness and visual or cognitive changes that may not be reversible.
A person's ongoing PML risk is assessed using factors such as:
- The presence of antibodies to the John Cunningham virus on blood testing
- Previous treatment of immunosuppressive drugs, such as mitoxantrone
- Taking natalizumab longer than two years
Due to the PML risk, natalizumab is generally reserved for use in people whose MS can't be controlled with first line therapy use.
Alemtuzumab (Lemtrada). This drug helps reduce relapses of MS by targeting a protein on the surface of immune cells and depleting white blood cells. This effect can limit potential nerve damage caused by the white blood cells, but it also increases the risk of infections and autoimmune disorders.
Treatment with alemtuzumab involves five consecutive days of drug infusions followed by another three days of infusions a year later. Infusion reactions are common with alemtuzumab.
Due to the risks associated with alemtuzamab, the FDA recommends extensive screening prior to using the drug. It's only available from registered providers, and people treated with the alemtuzumab must be registered in a special drug safety monitoring program.
Mitoxantrone. Mitoxantrone is an immunosuppressive drug that's approved for treating rapidly worsening relapsing MS and the only medication approved to treat secondary progressive MS, an advanced form of relapsing MS.
It's given intravenously and use is limited to a maximum of two years because of important side effects, including damage to the heart muscle. It is also associated with the development of blood cancers, such as leukemia. Due to these side effects and the availability of other therapies, mitoxantrone is used only in exceptional circumstances.
April 08, 2017
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