Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Substances called interferons are immunomodulatory (meaning they affect the action of the immune system) drugs that have been approved to treat
multiple sclerosis. Interferons are also made by the body, mainly to combat viral infections. Interferons have been shown to decrease relapses by about one-third (if compared to patients receiving placebo) and delay progression of the disease. Common side effects include flu-like symptoms (which tend to disappear with time) and injection site reactions (which can be minimized with analgesics, rotation of injection sites, and local measures to prepare the skin prior to injection). Interferons include interferon beta-1a (Avonex) which is given once a week as an injection into the muscle
interferon beta-1a [(Rebif), which is given three times per week as an injection below the skin)], and interferon beta-1b
[(Betaseron), which is given every other day as an injection below the skin].
Glatiramer acetate (Copaxone) is a mixture of amino acids used to treat
multiple sclerosis. Glatiramer acetate has been shown to decrease the relapse rates of
multiple sclerosis by about one-third (if compared to patients receiving placebo) and appears to also have an effect on the overall progression of
multiple sclerosis. Common side effects with Glatiramer acetate include a sensation of chest tightening following the injection, and injection site reactions which may include rare skin lesions referred to as lipoatrophy. Copaxone is given every day as an injection below the skin.
Natalizumab (Tysabri) is a monoclonal antibody
that binds to white blood cells and interferes with their movement from the
bloodstream into the brain and spinal cord. White blood cells are thought to
play a role in causing the nervous system damage in multiple sclerosis.
Tysabri decreases relapses by about two- thirds (if compared to patients
receiving placebo) and reduces the accumulation of disability, but carries a
warning for increasing the risk of progressive multifocal encephalopathy (PML), a potentially fatal brain infection. Because of this risk, Tysabri can only be given to patients that have registered for treatment under a controlled drug distribution program.
Fingolimod (Gilenya®) is a daily oral medication to treat MS that was approved by the US FDA in September 2010 as the first oral medication to treat MS. Although the exact mechanism of action of fingolimod is unclear, it appears to work by reducing the number of lymphocytes (a type of white blood cell that is important for immunity and the inflammation process) in the blood.
Fingolimod is taken daily in capsule form. It is not a cure for MS, but it has been shown to decrease the number of MS flares and slow down the development of physical disability caused by MS.
Like many injectable therapies for MS, the long-term safety of fingolimod is unknown. The most common side effects of fingolimod are headache, flu, diarrhea, back pain, elevations of liver enzymes in the blood, and cough. Other side effects are also possible including eye problems, so those taking this drug should have regular ophthalmologic evaluations.
Several drugs that suppress the immune system and are used to treat
cancer have also been used to treat
multiple sclerosis, but they may make people with multiple sclerosis very ill, especially if not used with caution. Mitoxantrone (Novantrone) is a chemotherapy agent that has been approved by the FDA to treat
multiple sclerosis. Treatment with mitoxantrone requires monitoring of cardiac function, and there is a fixed limit to the dose that can be administered to patients. It also carries the long-term risk of leukemia. For these reasons, Novantrone is typically reserved for patients with more aggressive forms of
New research and treatment methods are currently being investigated and are expected to offer some hope to people with