Multiple Sclerosis (cont.)
Multiple Sclerosis Medications
There are several treatment options for multiple sclerosis. The following is a brief summary of the drugs approved by the FDA to treat multiple sclerosis. For more information, consult your health care practitioner.
- 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 U.S. FDA in 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. 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.
- Teriflunomide (Aubagio) is another newer oral medication for MS. This medication works by inhibiting dihydroorotate dehydrogenase, a mitochondrial enzyme involved in pyrimidine synthesis. Its side effects can include reduced white blood cell counts and liver problems. It is recommended that those taking this drug receive regular blood tests after beginning the medication.
- Dimethyl fumarate (Tecfidera) is the third oral medication approved by the FDA to treat multiple sclerosis. It is used for relapsing MS, and its action is by activating the Nrf2 antioxidant response pathway, a cellular signaling system that helps protect cells from oxidative stress. Because it can also reduce the number of white blood cells, it is recommended that blood counts be measured prior to starting treatment with this drug.
- 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 multiple sclerosis.
- Dalfampridine (Ampyra) is a potassium-blocking drug that has been approved as a treatment to improve walking in patients with multiple sclerosis.
- New research and treatment methods are currently being investigated and are expected to offer some hope to people with multiple sclerosis. In particular, new research studies have shown that skin patches containing myelin peptides may be a promising therapy.
In addition to drugs that target the disease process, other medications may be given to help relieve certain symptoms of MS.
- Corticosteroid medications may be given to aid recovery from acute relapses of the condition and to decrease inflammation of optic neuritis.
- Tricyclic antidepressants are often given to reduce the nerve pain associated with MS.
- Muscle relaxants such as baclofen may relieve muscle spasticity, pain, and stiffness.
- Selective serotonin reuptake inhibitors (SSRIs) may be prescribed for depression and mood changes.
- The oral phosphodiesterase type 5 inhibitors (for example, sildenafil, tadalafil, vardenafil) can be given to treat sexual dysfunction.
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