Several different types of medication may be prescribed to people who have multiple sclerosis (MS).
One type, known as disease-modifying drugs, can prevent acute MS attacks, or relapses, and in some cases slow the progression of the disease, thereby preventing physical and cognitive disability.
Other drugs, primarily corticosteroids, are used to help control severe MS attacks.
There are also numerous drug treatments for managing various MS symptoms, such as pain, tremors, walking difficulty, and muscle spasticity.
Disease-Modifying Medication for MS
Disease-modifying medication is aimed at slowing the progression of multiple sclerosis and lowering the frequency and severity of acute attacks in people who have the relapsing form of the disease, known as relapsing-remitting MS (RRMS).
These drugs also reduce the development of new lesions (areas of damage in the brain), as seen on MRI scans.
For people with primary-progressive MS (PPMS), only one disease-modifying medication, Ocrevus (ocrelizumab), has been shown to help. PPMS is marked by a gradual worsening of symptoms, without the acute attacks that occur in RRMS.
The Food and Drug Administration (FDA) has approved the following drugs to treat relapsing-remitting MS:
- Aubagio (teriflunomide), a once-daily capsule that blocks the production of immune-system cells
- Avonex and Rebif (interferon beta-1a) and Betaseron and Extavia (interferon beta-1b), which are injected into the muscle (intramuscular) or under the skin (subcutaneous). It’s believed that these drugs work by controlling inflammation in the central nervous system (CNS).
- Copaxone (glatiramer acetate) and Glatopa (glatiramer acetate), a subcutaneous injection that attracts immune-system cells (T cells) that would otherwise attack myelin sheaths
- Gilenya (fingolimod), a once-daily pill that prevents T cells from getting out of lymph nodes and into the bloodstream
- Novantrone (mitoxantrone), an immunosuppressant drug administered by IV infusion, and the only FDA-approved drug for secondary-progressive MS
- Ocrevus (ocrelizumab), an intravenous (IV) infusion that works by targeting CD20-positive B lymphocytes and destroying them, and the only drug approved for PPMS
- Plegridy (peginterferon beta-1a), a longer-lasting form of interferon
- Tecfidera (dimethyl fumarate), a twice-daily oral capsule that lowers CNS inflammation and the ability of immune cells to get into the CNS
- Tysabri (natalizumab), an intravenous (IV) infusion that works by binding to white blood cells and interfering with their movement from the bloodstream into the CNS
- Zinbryta (daclizumab), a monthly subcutaneous injection that acts on the immune system to reduce MS-related inflammation. It’s recommended for people who haven’t responded to two or more other MS drugs.
The FDA has also approved the IV drug Lemtrada (alemtuzumab) for people who have forms of MS that include relapses and haven’t responded well to two or more types of disease-modifying medication.
Alemtuzumab works by rapidly depleting the body’s supply of immune (T and B) cells, which temporarily stops the immune-system effects on your CNS and allows your body to create new cells, which might not attack myelin sheaths.
The FDA recommends using it only as a second-line therapy (after other drugs have failed) because it increases the risk of complications, including severe infections, development of new autoimmune diseases, and other potentially dangerous conditions.
Treatments for Acute Attacks
For acute attacks of MS, especially severe ones that interfere with a person’s mobility, safety, or ability to function, doctors may prescribe short-term, high-dose corticosteroids.
These drugs help treat attacks by reducing inflammation in the body.
Examples of corticosteroids include:
- Decadron (dexamethasone)
- Deltasone (prednisone)
- Solu-Medrol (methylprednisolone)
People who cannot tolerate the side effects of high-dose steroids may be prescribed H.P. Acthar Gel (corticotropin), which stimulates the adrenal cortex to secrete various steroid hormones.
For people whose symptoms haven’t responded to steroids, a treatment called plasmapheresis (plasma exchange) is available.
Plasma is the liquid part of your blood, and it contains autoantibodies, a type of protein that the immune system produces to attack the body’s cells and tissues.
Plasmapheresis involves separating plasma from your blood cells, and then returning the blood cells to your body along with fresh plasma or a plasma substitute.
Drugs for MS Symptom Management
Given the wide range of symptoms caused by MS, doctors often also prescribe a variety of drugs to ease individual symptoms.
These can include:
- Ampyra (dalfampridine), an oral medication used to improve walking in adults with MS
- Analgesics (pain medication)
- Antibiotics to treat urinary tract infections (UTIs), respiratory infections, and other infections
- Anticonvulsants to treat neuropathic pain or tremors
- Antispasmodics, such as baclofen, and muscle relaxants, such as Zanaflex (tizanidine), to ease muscle spasticity
- Medication to treat gastrointestinal problems, such as nausea, ulcers, and constipation
- Disease-Modifying Therapies for MS;