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Relapsing-Remitting MS Medication: Finding the Right One

Treatment has come a long way.

Gone are the days when multiple sclerosis destined patients to a life in a wheelchair. Treatments for MS have advanced, often dramatically changing the course of the condition and improving lives for MS patients.

Patients with relapsing-remitting multiple sclerosis (RRMS) experience periods of attacks on the central nervous system, leading to new or worsened symptoms, followed by a period of remission, when MS symptoms stop or subside. RRMS is the most common type of multiple sclerosis, affecting 85 percent of patients. (Learn more about what relapsing-remitting multiple sclerosis is here.)

After a diagnosis of RRMS, patients meet with their doctors to develop a treatment plan. “We do blood testing to see which treatment options might be best and safest for the patient,” says Michelle Fabian, MD, a neurologist for The Mount Sinai Hospital in New York City. “We take a lot of factors into account.”

The goal of treatment is to prevent MS relapses and keep symptoms from worsening. There are two main kinds of medications for MS.

  • Immunomodulators make the immune system work more gently. If effective, immunomodulators would prevent attacks from damaging the myelin and causing relapses.

  • Immunosuppressants take away parts of the immune system. “An immunosuppressant will typically carry a higher risk,” says Dr. Fabian, “because that patient will not be able to fight an infection to the same degree as somebody who didn’t have that immunosuppressant.”

These can come in different forms:

  • Injectable medications are an older form of treatment and less effective than newer options. Patients inject these themselves using a pen-like device against the skin and pressing a button, which releases the injection. These include medications like interferons, glatiramer acetate, and daclizumab.  Some patients may decide against injectables—not everyone can stomach a daily needle.

  • Oral medications, such as teriflunomide, fingolimod, and dimethyl fumarate, can be taken once or twice a day. Since the introduction of pills for MS, most patients choose this option over injectables, according to Dr. Fabian.

  • Infusion medications are delivered through an IV every four weeks (at least) to a year (at most) and include alemtuzumab, mitoxantrone, ocrelizumab, and natalizumab. Infusion medications are potentially the most powerful and effective form of treatment for MS, according to Dr. Fabian, but they also carry the most risk. Longer-term risks may even include a greater chance of developing serious health issues such as heart disease and leukemia, according to the Multiple Sclerosis Association of America, so patients taking infusions for MS require careful monitoring by a doctor.

The right MS treatment option depends on the patient and the specific symptoms they experience. Some of the factors affecting this decision include the patient’s relapse history, symptoms, and results from MRIs or other exams. Doctors typically only prescribe the high-powered, yet riskier, medications for those with more severe relapses and neurological damage.

Of course, the patient’s input matters here, too. “We have some patients who are very worried about risk,” says Dr. Fabian. “They would rather start on one of the safer but lower-power treatments, and if they had new symptoms or a new lesion, they would consider maybe going to a higher-risk drug.”

No matter what you choose, treatment for MS can prevent further lesions, symptoms, and relapses. Learn more about how new medications have changed the outlook for patients here.

Michelle Fabian, MD

This video features information from Michelle Fabian, MD. Dr. Fabian is the assistant professor of neurology at The Mount Sinai Hospital in New York City.

Duration: 3:31. Last Updated On: Jan. 25, 2018, 9:10 p.m.
Reviewed by: Preeti Parikh, MD . Review date: Jan. 18, 2018
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