Now that you finally have a name -- multiple sclerosis -- to match the symptoms that have been plaguing you, you've probably got a lot of questions about how to treat those symptoms and keep your condition from getting worse. Although researchers haven't yet discovered a cure for MS, there are many effective medications to help manage your disease. Your doctor will work closely with you to find the treatment that works best for you while causing the fewest side effects.
Here is a rundown of your MS treatment options.
Changing the Course of Your MS: The Disease-Modifying Drugs
If
you have active relapsing-remitting MS, your doctor will first treat
you with one of the disease-modifying drugs. They're called
disease-modifying drugs because they can actually slow down the
progression of MS and prevent relapses to keep you active for longer.
These drugs work by suppressing the immune system so that it doesn't
attack the protective coating (myelin) surrounding the nerves.
Disease-modifying drugs that reduce the number of flares include:
- interferon beta 1b ( Betaseron, Extavia)
- glatiramer acetate ( Copaxone)
Disease-modifying drugs that have been shown to reduce flares and slow progression of MS include:
- interferon beta 1a ( Avonex, Rebif)
- teriflunomide (Aubagio)
- fingolimod ( Gilenya)
- mitoxantrone ( Novantrone)
- dimethyl fumarate ( Tecfidera)
- natalizumab ( Tysabri)
Both
the interferon drugs and Copaxone are considered to be very safe. Most
of the side effects that do occur stem from the injection itself,
including redness, warmth, itching, or dimpling of the skin over the
injection site. With the interferon drugs, it's common to have flu-like
symptoms --aches, fatigue, fever, and chills -- but these should fade
within a few months. The interferon drugs can also slightly increase
your risk for real infections by lowering the number of
white blood cells that help your immune system fight off illnesses.
There
are three oral drugs available to treat the relapsing form of MS.
Aubagio is a once-a-day tablet. The most common side effects of Aubagio
include diarrhea, abnormal liver tests, nausea, and hair loss. However,
Aubagio does carry a “black box” warning -- the FDA’s most serious
warning -- because of liver problems and birth defects. Doctors should
periodically do liver function testing in those on the drug. The
medication should not be taken bypregnant women.
Gilenya
is another once-daily tablet for relapsing MS. Before you can take this
drug, you'll need to have a chickenpox vaccine if you haven't already
had chickenpox. That’s because during a clinical study one person died
from chickenpox while taking Gilenya. Gilenya's most common side effects
include headache, diarrhea, back pain, cough, and abnormal liver tests.
Because Gilenya may cause a slow heart rate, your doctor will watch you
closely after your first dose. The FDA says it was investigating a man
in Europe who developed a rare but sometimes fatal brain disease called
progressive multifocal encephalopathy (PML) while taking Gilenya.
Changing the Course of Your MS: The Disease-Modifying Drugs continued...
Tecfidera
is a twice-daily tablet for relapsing MS. It may cause low levels of
immune cells, so your doctor will do regular blood tests to check for
that. An active ingredient similar to the one in Tecfidera has been
linked to four cases of PML. However, this has not been seen in patients
taking Tecfidera. The four patients also had additional risk factors
for PML. Tecfidera's most common side effects are flushing, stomach
pain, diarrhea, nausea, and vomiting.
If
these drugs don't work for you, the next step might be to try a
different disease-modifying medication called natalizumab (Tysabri).
Tysabri prevents immune cells from getting to your brain and spinal cord
where they can damage nerves. This drug is used only if other
medications fail because it has been linked to PML. If you do take this
drug, you will be monitored very carefully while on it. According to the
FDA, PML incidence per 1,000 patients is 0.3 cases during the first two
months of treatment, 1.5 cases during 25 to 36 months of treatment, and
0.9 during 37 to 48 months of treatment. A blood test can help doctors
assess risk for PML. The test looks for evidence of exposure to the JC
virus, which causes PML.
In
the most severe cases of MS that aren't responding to medication,
doctors may prescribe mitoxantrone (Novantrone). This chemotherapy drug,
which was originally designed to treat cancer, suppresses the immune
system to prevent it from attacking nerve coverings. Novantrone is used
sparingly, though, because it carries a FDA “black box” warning because
of risks of heart damage and a type of leukemia.
Treating Exacerbations
Your
MS medications are designed to prevent flare-ups, but you can still get
exacerbations and sometimes they can seriously interfere with your
ability to get around. Mild exacerbations will eventually go away on
their own, so if they're not bothering you, you don't need to treat
them. On the other hand, if a flare-up is getting in the way of your
life, your doctor may give you high-dose steroids through a vein
(intravenously) to bring the flare-up to a speedier end. Steroids won't
slow down the course of your overall disease, though.
In
a small percentage of people with very severe relapses that don't
respond to steroids, doctors might recommend a technique called plasma
exchange. During this procedure, your blood is removed and the liquid
portion (plasma) is separated out from the white and red blood cells.
The plasma is replaced before the blood is put back into your body.
Other Ways to Cope
To
target specific symptoms of MS, including fatigue, muscle
stiffness, depression, and bladder problems, you can take other
medications, including:
- Muscle stiffness and spasms: muscle relaxants such as tizanidine ( Zanaflex) and baclofen ( Lioresal), or sedatives like diazepam ( Valium) and clonazepam ( Klonopin).
- Fatigue: amantadine ( Symmetrel), modafinil (Provogil), and armodafinil ( Nuvigil)
- Depression: antidepressants such as fluoxetine ( Prozac), sertraline ( Zoloft), and bupropion ( Wellbutrin).
- Bladder problems: oxybutynin ( Ditropan) or tolterodine ( Detrol)
Working
with a physical therapist can teach you how to do exercises that will
help keep you more active. If you have lost some physical ability, a
cane, walker, or braces can make it easier to get around.
It's
vital to start medication for your MS as early as possible, and to
continue taking it over the long term so that it can prevent further
damage and slow your disease from getting worse. Because you will be on
the MS drugs indefinitely, it's important for you to be comfortable with
them. If your side effects are intolerable or the medication isn't
helping, talk to your doctor. You may need to switch to a different
drug.
Story Source: The above story is based on materials provided by WebMD Note: Materials may be edited for content and length
