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.
Dr. Fabian is the assistant professor of neurology at The Mount Sinai Hospital in New York City.
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A lot of people do know
people in their community,
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family members who have MS
before it was treatable.
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a lot of people think of that as MS.
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And of course, that is MS,
but that is untreated MS.
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Now that we have treatments, we think
the condition has significantly changed.
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After the diagnosis of relapsing-remitting
MS is made, patient comes in and
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talks to the doctor about the treatment
options, of which we have many.
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We do blood testing to see which treatment
options might be best and safest for
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the patient, and
we take a lot of factors into account.
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Some of our medications
are called immunomodulators.
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They work a little more gently,
just trying to change the immune system
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to make it a little gentler and
to stop those attacks from recurring.
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And we have a few of those.
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We also have immunosuppressants.
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Those are medications that actually
take away parts of the immune system.
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They target different cell types and
actually remove them, so
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that the cell can't form a new lesion.
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An immunosuppressant will
typically carry a higher risk
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because that patient would not
be able to fight an infection
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to the same degree as somebody who
didn't have that immunosuppressant.
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So we have the older medications.
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Those are injections.
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Those are small needles and
they're usually like a pen type of needle,
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where a patient puts it on their skin and
just kind of presses the button.
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They work maybe the least
well of our medications.
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We have pills and we have multiple
pills that are out now which is great.
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So those medications are different,
each one of them.
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Two are once a day and
then one is twice a day.
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We also have infusion medications.
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Those are IV.
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And we have multiple different ones.
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And so each medication has its own time
of how long it takes to get the IV,
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how often you get it.
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And those are the most powerful,
maybe the best of our treatments, but
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also carry the most risk.
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So when we look at a patient and we think
about which medication is right for them,
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we look at their history, their relapse
history, the symptoms they have,
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how their exam looks right now.
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If somebody's had very mild relapses,
they look neurologically normal.
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We might think of one of
the milder treatments for them.
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If a patient has had more severe relapses,
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we might think of one of
the more higher power treatments.
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We also think about the patient and
of course talk to the patient and
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get their take on it.
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We have some patients who
are very worried about risk.
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They would rather start on one of
the safer but lower power treatments.
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And if they had new symptoms or
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a new lesion, then they would consider
maybe going to a higher risk drug.
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There are some patients that don't mind
injecting themselves with the medication.
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And before we had the orals,
that's what we had, and so
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many patients were doing that.
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Most patients now would
rather not do that.
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The injectables do tend to have the lowest
risk, but most people, I would say,
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would prefer an oral, or maybe even an IV.
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Because then you get it.
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And then you don't have to think
about it until the next time you go.
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Long-term treatments for multiple sclerosis. Cherry Hill, NJ: Multiple Sclerosis Association of America. (Accessed on April 12, 2021 at https://mymsaa.org/ms-information/treatments/long-term/.)Medications. New York, NY: National Multiple Sclerosis Society. (Accessed on April 12, 2021 at https://www.nationalmssociety.org/Treating-MS/Medications.) Multiple sclerosis (MS—adult). New York, NY: Mount Sinai Hospital, 2016. (Accessed on April 12, 2021 at http://www.mountsinai.org/patient-care/service-areas/neurology/diseases-and-conditions/multiple-sclerosis.) Primary progressive MS. New York, NY: National Multiple Sclerosis Society. (Accessed on April 12, 2021 at https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS.) Relapsing-remitting MS (RRMS). New York, NY: National Multiple Sclerosis Society. (Accessed on April 12, 2021 at https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Relapsing-remitting-MS.) Relapsing-remitting multiple sclerosis. Baltimore, MD: John Hopkins Medicine. (Accessed on April 12, 2021 at https://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/relapsing-remitting_multiple_sclerosis_134,54.)