Living with multiple sclerosis (MS) means managing a sometimes unpredictable disease, with relapses and times of remission. You may already be taking medications that ease your bladder and bowel symptoms, help you have better balance and gait, help you feel less fatigued, and soothe your nerve inflammation that happens during a flare.
But while you’re treating daily symptoms of MS that impact your quality of life, you’re also looking at the larger picture: finding a therapy to slow your overall disease progression.
Although there’s not yet a cure for MS, research is working on new and better disease-modifying therapies (DMTs). These advanced treatments go beyond symptom management. They can help make your attacks less frequent and less severe, and prevent new lesions from growing so that your disease worsens more slowly.
It’s best to start a DMT as soon as possible after your diagnosis, regardless of your age. If you have relapsing-remitting MS (RRMS), it may slow or stop the progression to secondary progressive MS (SPMS). Current DMTs can treat SPMS but are slightly less effective for this type of MS than for RRMS, so getting on one early is key.
Some of these medications you take by mouth, some you get as a shot, and others are infusions you get through an IV.
What Are Disease-Modifying Therapies for Relapsing MS?
Advanced treatments for relapsing MS work by directly targeting the inflammation in your central nervous system (spinal cord and brain). They include:
All of these treatments reduce inflammation in your brain and spinal cord by altering your immune system and slowing the course of your disease. They do this in different ways.
Some target myelin-damaging cells to destroy them. Others block the making of other cells that damage the body, or keep harmful cells from entering your central nervous system. Some may even have antioxidant properties that protect the brain and spinal cord.
Doctors measure how well DMTs work by tracking your number of relapses over time. They also watch for inflammation that doesn’t lead to visible relapses through magnetic resonance imaging (MRI) scans. Research shows these treatments are anywhere from 29% to 68% effective, depending on the drug class.
The main benefits of DMTs include:
- Fewer relapses
- Less severe relapses
- Greater recovery from relapses, which can slow overall disability
What Are Immune Cell Inhibitors?
Immune cell inhibitors are medications that "calm down" or put a stop to specific immune cells in your body that are mistakenly attacking the protective covering of your nerves (myelin). Immune system cells, such as B cells and T cells, work to rid your body of germs and bacteria so you don’t get sick. In MS, they begin to attack the cells that make up your myelin, which damages it and causes disease symptoms.
Immune cell inhibitors work to slow down or stop this process in different ways, including;
- Binding to proteins on the surface of these cells, killing them
- Binding to proteins on the surface of cells, preventing them from crossing the blood-brain barrier so they can’t reach your spinal cord or brain
- Disrupting the replication process for certain immune cells so there are fewer made in your body
Immune cell inhibitors can be part of several drug classes, including:
- Monoclonal antibodies, which are lab-made proteins that act like the antibodies already inside you. Scientists make them to specifically target the cells causing nerve inflammation and damage.
- Anticancer or chemotherapy drugs that work by interfering in the growth of immune cells, slowing or stopping it
- Immunomodulators, which get in the way of the normal action of certain cells
What Are NRF2 Agonists?
Agonists are drugs that bind to receptors on cells and mimic the action of the substance that typically attaches to that receptor. NRF2 stands for nuclear factor erythroid 2-related factor 2. NRF2 is a transcription factor, which is a protein that regulates the process of copying DNA into RNA.
Researchers aren’t sure the exact way NRF2 agonists work in the body, but when NRF2 is activated, it binds to specific DNA sequences in genes called antioxidant response elements (AREs). This triggers a process that helps protect brain and spinal cord cells against inflammation and damage.
What Are S1P Receptor Modulators?
S1P stands for sphingosine-1-phosphate, a fatty compound (lipid) signaling molecule involved in cell growth, survival, and migration. Receptor modulators bind to a cell and “modulate,” or change, its normal function.
S1P receptor modulators work by binding to a specific receptor on immune cells called lymphocytes. This traps the cells inside lymph nodes and keeps them from moving through the body to the central nervous system. This prevents further damage to your brain and spinal cord. These may also work in more direct ways in your central nervous system.
What Are Interferons?
Interferons, also sometimes called beta interferons, are lab-made versions of a protein you have in your body that dampens inflammation. Researchers haven’t found the exact way they work yet, but they know that interferons change the balance of chemical messengers called cytokines in your body.
You take interferons as a shot in either your skin or muscle. You give yourself the shot at home with an injector pen as often as every other day or as far apart as every two weeks. Interferons tend to have some of the lowest risk of side effects out of all the DMTs.
5 Things to Consider When Choosing a Treatment
As you’re exploring advanced MS treatment options with your doctor, you’ll want to think through the benefits, side effects, and the way you’ll take the treatment before landing on a choice. Through careful consideration and shared decision-making, you can move forward smartly.
Keep these five points in mind:
How you take the medication
Some DMTs are tablets you take by mouth. Others are medications you inject into your skin yourself. Some are infusions you get through an IV – and these require a trip to an infusion center. You may worry you’ll forget to take an oral medication at home, you may be uncomfortable with needles, or you may not have time in your schedule to set aside for an infusion session. Think through what method will help you stick to your treatment plan.
Potential side effects
Depending on how powerful your DMT is, your side effects could be uncomfortable and affect your quality of life. Some DMTs come with rare but very serious side effects such as brain infections. Others cause side effects you’d have with some cancer drugs, such as hair loss, nausea, and fatigue. Any drug that lowers your immune system function – which most DMTs do – also raises your risk of getting infections.
Your other conditions
If you’re pregnant, breastfeeding, or thinking of getting pregnant, some DMTs won’t be an option for you. Others can increase the risk of depression, so if you’re living with depression already, you’ll want to be aware of that. You also can’t take many DMTs if you’re HIV-positive, because of the effect on your immune system. Be sure your doctor knows your medical history as you discuss which DMT might be right for you.
Whether you’ve tried other DMTs
You may have already tried one or more DMTs and need to switch because of side effects, or because they didn’t reduce your inflammation or number of relapses. You and your doctor can talk about what may not have worked before and how another choice might be different.
Cost
Managing MS comes with many expenses, and DMT medications can be some of the most costly. Talk to your insurance company to find out what your out-of-pocket expense will be for different DMT options and research what choices you may have for assistance elsewhere to help cover costs.