Multiple Sclerosis Disease Modifying Treatments

Multiple Sclerosis Disease Modifying Treatments

So how do you treat Multiple Sclerosis? Is there a cure for MS? Well, no, at the moment, there is no cure for Multiple Sclerosis but there are many drug therapies available for the treatment and management of MS and the many symptoms associated with the disease. With the help of the available MS therapies most people live completely normal lives!

The therapies that are typically used to manage Multiple Sclerosis are known as “Disease Modifying Drugs” or “DMD’s” for short (also called Disease Modifying Treatments – DMTs – by some). These drugs are not meant cure Multiple Sclerosis or even make existing symptoms of the disease go away; Instead, they aim to “modify” the course of the disease by reducing the number of flare ups and  exacerbations/relapses you may experience over a given period of time. Remember, a “flair up” is the appearance of old symptoms and a “relapse/exacerbation” is the appearance of new symptoms which can mean new lesions (plaques) on an MRI. The more lesions you have over time, the greater your chances of developing long-term disability (symptoms that do not go away). These drugs come in the forms of injections, oral medications, and drugs that are administered via intravenous (IV) infusions; they all work in slightly different ways to help control the course of Multiple Sclerosis over time.

Below is a list of the current disease modifying drugs available on the market;

Injections

Name
Type
Frequency
Dose
Copaxone
Subcutaneous
Every Day
20mg*
Avonex
Intramuscular
Once a Week
30mcg
Rebif
Subcutaneous
3 Times a Week
44mcg**
Betaseron
Subcutaneous
Every Other Day
250mcg
Extavia
Subcutaneous
Every Other Day
250mcg
*Also available as 40mg to be taken 3 times a week.
**When starting Rebif you start at 8.8mcg and increase to 22mcg and finally 44mcg over 4 weeks. 
Oral Medications
Name
Type
Frequency
Dose
Tecfidera
Oral
2 Times a Day
240mg*
Gilenya
Oral
Every Day
0.5mg
Aubagio
Oral
Every Day
7-14mg**
*When starting Tecfidera you start off at120mg for one week and then switch to 240mg a week thereafter.
**Aubagio is available as a 7mg and 14mg pill.
Intravenous Medications
Name
Type
Frequency
Dose
Tysabri
IV
Once Every 4 Weeks
300mg
Novantrone
IV
4 Times a Year
140mg*
 *Novantrone has a lifetime cumulative dose limit of approximately 8-12 doses over 2-3 years.

Choosing an MS therapy should be done carefully because there are many different options and each medication comes with a different routine and set of side effects.

No one likes needles but most people start off on Copaxone when they are first diagnosed with MS.
Copaxone is typically well tolerated and easy to use. Most injection therapies (like Copaxone) have an injector device that allows you to load the pre-filled syringe at a set depth (which may vary depending on the injection site; examples include the arms, thighs, stomach, and hips) and inject with the simple push of a button allowing you to never really see the needle.

The oral medications may seem like something that most people would want to rush to but they are relatively new. There are a well known set of side effects for these medications but because long-term testing has not really been done yet, there are probably a lot more that are not on the list as of yet.

Now, the IV Infusions. Tysabri is the main one here, as Novantrone (a type of chemotherapy) is not as commonly used. These therapies are usually used when no other therapy seems to work for a patient; These drugs  are much stronger medications with more of a risk factor than the other DMDs. These medications are not what you would run to when you are first diagnosed with MS, they are more of a “last resort” for lack of better terms. Many people fear Tysabri (for example) because of the risk of developing a rare and sometimes fatal brain disease called PML (Progressive Multifocal Leukoencephalopathy) but with the right precautions and regular testing, this risk is much lower than it once was.

With all treatments it comes down to one question; do the benefits outweigh the risks?

Last Updated; July 26, 2014

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