Multiple Sclerosis - Treatments

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What are the treatments for multiple sclerosis?

There are many issues for the patient and physician to consider in treating multiple sclerosis. Goals may include:

  • improving the speed of recovery from attacks (treatment with steroid drugs);
  • reducing the number of attacks or the number of MRI lesions; or
  • attempting to slow progression of the disability (treatment with disease modifying drugs or DMDs); and
  • relief from complications due to the loss of function of affected organs (treatment with drugs aimed at specific symptoms).

Most neurologists will consider treatment with DMDs once the diagnosis of relapsing-remitting multiple sclerosis is established. Many will begin treatment at the time of the first attack of MS since clinical trials have suggested that patients in whom treatment is delayed may not benefit as much as patients who are treated early.

It is important for patients to talk to their doctor before deciding to go on therapy since DMDs differ in their uses (for example, one DMD may be used for slowing progressing disability but not for treatment of the first attack of MS; another DMD may be used for reducing relapses but not for slowing progressing disability). Finally, utilizing support groups or counseling may be helpful for patients and their families whose lives may be affected directly by multiple sclerosis.

Once goals have been set and a decision regarding DMDs has been made, initial therapy may include medications to manage attacks, symptoms, or both. An understanding of the potential side effects of drugs is critical for the patient because sometimes side effects alone deter patients from drug therapy. Patients may choose to avoid drugs altogether or choose an alternative drug that may offer relief with fewer side effects. A continuous dialogue between the patient and physician about the medications is important in determining the needs for treatment.

Although the efficacy of DMDs has been proven in clinical trials, their ability to decrease the frequency of relapses varies in patients with relapsing MS. It is difficult to clearly delineate these differences in the absence of comparative clinical trials, and physicians should consider this limitation in interpreting the reported relapse reduction rates from individual placebo-controlled trials. It is not acceptable to compare data across trials; however, the following relapse reduction rates vs. placebo for some of the DMDs from the pivotal trials are provided for general information purposes:

  • Avonex: 18% (annual relapse rate reduction)
  • Copaxone: 29% at 2 years
  • Rebif: 32% at 2 years
  • Betaseron and Extavia: 31% (annual relapse rate reduction)
  • Tysabri: 68% (annual relapse rate reduction)
  • Gilenya: 54% (annual relapse rate reduction)
  • Teriflunomide: 31% (annual relapse rate reduction)

In head-to-head trials in patients with relapsing MS, both Rebif and Gilenya have shown superiority to Avonex in reducing relapse rates and MRI lesions (EVIDENCE and TRANSFORMS trials, respectively).

Drugs known to affect the immune system have become the primary focus for managing multiple sclerosis. Initially, corticosteroids, such as prednisone (Deltasone, Liquid Pred, Deltasone, Orasone, Prednicen-M) or methylprednisolone (Medrol, Depo-Medrol), were widely used. However, since their effect on the immune system is nonspecific (general) and their use may cause numerous side effects, corticosteroids now tend to be used to manage only severe multiple sclerosis attacks (that is, attacks leading to physical disability or causing pain).

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See what others are saying

Comment from: apprehensive, 45-54 Female (Patient) Published: September 07

I was diagnosed with MS in 2004 after being mis-diagnosed with Lupus 10 years prior. It got so bad that I was in a wheel chair. I lost control of my bladder and bowels. I took 2 years of Betaseron without having any improvements. I went through three total treatments of CAMPATH, which is experimental, but soon to be approved for use for MS. It turned me around. I am walking without assistance from anything, have been walking 4 miles a day, I've had a decreased number of attacks/flair-ups, and my fatigue is way down. It's been 3 years since my last dose and my last MRI showed two new very small lesions from the previous year. I believe in this drug! It turned my life around. I pray that this drug will be approved soon so people will have another choice to treating their MS. I can't begin to sing its praises. It is the most near normal I have felt in many years. Now it is wearing off and symptoms are reappearing and this medication is off the market and it can't be used until it is approved. I am very scared of what I will be facing next.

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Comment from: Tina, 45-54 Female (Patient) Published: April 12

I was diagnosed with MS in 2005 at the age of 44. I woke up one morning with numbness in my lower back and right leg. This was on a Thursday. By the weekend I was totally numb from the waist down. I couldn't feel my feet touching the floor. I saw my doctor on Monday and had an MRI to see if I had a disc problem. It was negative and she told me she feared MS. I was sent to a neurologist, had two more MRIs, and was told that night that I have four lesions on my spine MS. I did the steroid treatments for three days, got my feeling back, then went numb from the waist up. I received more steroid treatments. My neurologist and I decided to go with the Rebif therapy. I have been taking shots since 2005 and nobody would ever know that I have MS. I lead a totally normal life. My doctor started me on medication immediately and I believe that is why my symptoms are gone. My lesions have even shrunk.

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