17 Multiple Sclerosis Treatments
How MS is treated
There’s no question that multiple sclerosis is frustrating, with varying and often unpredictable symptoms that seem to throw curve balls at people with MS.
But in less than two decades MS has gone from an essentially untreatable disease to one that has almost a dozen medications that slow the progression of the disease (known as immune-modulating medications), in addition to multiple other drugs that relieve symptoms.
Here are the different options, from simple walking to sophisticated biological therapies, that people with MS can choose from:
A landmark 1996 study found that exercise even improved bladder and bowel control. And just being physically active with shopping and gardening (as much as the disease will allow) can be enormously beneficial as well.
A small study published in 2012 found not only behavioral improvements but also enhanced brain activation as measured by functional magnetic resonance imaging in patients who underwent a 10-session intervention to boost memory.
Swallowing difficulties, caused by damage in the areas of the brain that control muscles in this area, can potentially lead to choking and even aspiration pneumonia, in which bits of inhaled food trigger lung infections. Simple changes, like altering the texture of food a person is eating, can help.
The deep breathing, relaxation, and measured movements of yoga can also help. Some people with MS find that acupuncture is effective, although there have been no formal clinical trials on this topic.
Botox can calm these muscles so that the body removes waste more efficiently. “It’s sort of the same reason that Botox does some of its cosmetic magic, but for a different purpose,” says Nicholas LaRocca, Ph.D., vice president of healthcare delivery and policy research at the National Multiple Sclerosis Society (NMSS).
Generally women who take Aubagio and want to get pregnant will have to undergo chelation therapy to remove the drug from their body, says Leticia Tornes, M.D., a neurologist with the University of Miami Miller School of Medicine. Aubagio can linger in the body for as long as two years.
Steroids, one of the first drugs ever used to manage relapses, can be given orally or intravenously. Intravenous steroids seem to have the most benefit with the fewest side effects.
Older immune-modulating drugs are given as injections and reduce the annual risk of relapse by about 30%. Gilenya reduces the risk by 54%, says Dr. Tornes. The drug can slow heart rate so people need to have an electrocardiogram before their first dose and during the first six hours after.
Each drug is dosed a little differently and administered at different time intervals, Dr. Tornes says. Interferons are given by injection and patients need to have their blood monitored carefully for liver and immune cell problems while taking these drugs.
“If a patient doesn’t like having their blood drawn or they travel a lot or it’s not convenient to have multiple blood draws, sometimes this is used instead of interferon,” Dr. Tornes says.
Studies have put the risk of developing leukemia at 0.25% to 2.8% in different groups of patients with MS. "The risk of leukemia outweighs the benefit of the drug," says Dr. Tornes. "It does work well but we think it’s too much risk."
Again, patients’ blood needs to be carefully monitored as Tysabri carries with it a higher risk of PML or progressive multifocal leukoencephalopathy, a severe brain infection. The good news is that there are now ways to determine if one is at high risk for this side effect, says Dr. Tornes.
It is taken as a pill twice a day and is only available through a specialty pharmacy. The good news is that the drug company will provide it for free for three months. But if it works, it can cost you: $1,300 or more a month.
It’s not clear how the drug works. It is given in capsule form.
Two studies published in 2012 in the New England Journal of Medicine found that BG-12 reduced relapses by about 50%. If all goes well, BG-12 may be approved as soon as December of 2012.
That would make it the 10th disease-modifying treatment on the market for people with MS, Coetzee says. It would also be the third disease-modifying treatment in pill form.
Patients who took Lemtrada in trials had lower recurrence rates and less disability than patients taking Rebif. It requires five initial doses followed by infusions only once a year thereafter.
“It’s a very potent immune modifying drug that really reboots the immune system,” Coetzee says.