Treatments
The goals of treatment for MS are multi-fold and include:
- Slowing MS activity and progression
- Reducing the severity and duration of relapses
- Treating the individual symptoms of MS
There is currently no cure for MS and treatment generally focuses on patient-related aspects such as speeding recovery from attacks and managing symptoms. Treatment for attacks may include corticosteroids and (less commonly) plasma exchange while treatments for signs and symptoms can include physical therapy, muscle relaxants, agents to reduce fatigue, and other medications for sequelae such as pain, depression, bladder/bowel control problems and others that may be associated with underlying MS.
In addition to symptomatic management, there are several disease-modifying agents available. Along with the other components of MS care, these medications can help people manage their MS and reduce disease activity and impairment due to relapses. The agents in the table below are approved by the FDA to reduce disease activity and disability progression due to relapses for many people with relapsing forms of MS. Some data support the importance of early DMT initiation, although this is controversial.
In addition to FDA-approved agents, there are several agents in development, including siponimod, ozanimod, laquinimod, ibudilast, ofatumumab, and others. Notably, daclizumab which was FDA-approved in 2016, was withdrawn in March, 2018 due to encephalitis concerns.
| Agent | Approved | Type of MS |
| IFNb-1b SQ every other day | 1993, 2009 | Relapsing forms of MS, CIS |
| Glatiramer acetate SQ daily or 3x/wk | 1996 | RRMS, CIS |
| IFNb-1a IM weekly | 1996 | RRMS, CIS |
| IFNb-1a SQ 3x/wk | 2002 | RRMS |
| Mitoxantrone IV q 3mo | 2000 | Worsening RRMS, SPMS, progressive relapsing MS |
| Natalizumab q 4wks IV | 2004/2006 | RRMS |
| Fingolimod daily tablet | 2010 | RRMS |
| Teriflunomide daily tab | 2012 | RRMS |
| Dimethyl fumarate oral BID | 2013 | RRMS |
| Peginterferon-b 1a q 2wks | 2014 | RRMS |
| Alemtuzumab IV 3x/wk | 2014 | RRMS |
| Ocrelizumab IV q 6mo | 2017 | RRMS, PPMS |
RRMS: Relapsing-remitting MS; PPMS: primary progressive MS; SPMS: secondary progressive MS; CIS: clinically isolated syndrome
Please consult product labels for prescribing information on individual therapies.
References
- National Multiple Sclerosis Society. Medications. Available at: http://www.nationalmssociety.org/Treating-MS/Medications.
- Kuhlmann T, Lingfield G, Bitsch A, Schuchardt J, Bruck W. Acute axonal damage in multiple sclerosis is most extensive in early disease stages and decreases over time. Brain. 2002;125:2202-2212.
- Multiple Sclerosis Association of America. Treatments for MS. Available at: http://www.mymsaa.org/about-ms/treatments/.
- Mayo Clinic. Multiple Sclerosis. Available at: http://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/basics/treatment/con-20026689.
