The most common type of MS is relapsing-remitting MS (RMS). If you’re diagnosed with this type, you experience relapses of more intense symptoms that last at least a day before they dissipate. Another type of MS is primary progressive MS (PPMS). If you’re diagnosed with this one, you experience symptoms that gradually worsen over time.
For both types, most doctors recommend starting the disease-modifying therapy as early as possible, even if your symptoms are mild or spaced far apart, because each attack can create lesions that lead to permanent tissue damage and disability. Some patients with RMS develop a form of progressive MS, called secondary progressive MS, which worsens over time like primary progressive MS does.
Disease-Modifying Drugs
The goal of disease modifying drugs is to reduce the number of MS attacks you experience or slow its progression. Because MS is an autoimmune disease, many of the treatments suppress your immune system and raise your risk of infections, but each drug has its own unique array of potential side effects. Those symptoms make it especially important to ensure that you and your doctor discuss all of your medical history while deciding on your regimen.
There are a variety of disease-modifying drugs for patients with RMS, but, unfortunately, the Food and Drug Administration (FDA) has approved only one treatment for those with PPMS. It is Ocrevus (ocrelizumab), which is used for both types of MS.
Injections
Interferon beta Interferon beta drugs, such as Avonex (interferon beta 1A) and Extravia (interferon beta 1B), are some of the most commonly prescribed drugs to treat MS. Some newer drugs may be more effective, but Vijayshree Yadav, MD, a neurologist at Oregon Health and Science University, says, “They have a long history of safety, because they were approved in the early 1990s and they have been pretty well tolerated.”
As with any injection, you may experience injection-site reactions like redness and swelling. Over time, you may need to switch medications if your body develops antibodies to the interferons, rendering them less effective, or if the drug starts to damage your liver.
Copaxone or Glatopa (glatiramer acetate) is an injection that stops your immune system from attacking your body. It can also cause injection-site reactions. This is the drug Hadge was prescribed. “In the beginning, it was pretty rough. I had large welts after each injection that were painful [and] itchy and would remain for several days. After about four months, the reactions settled down and now I only get a small welt that [doesn’t] last very long, typically less than half a day, and they are not nearly as big or painful,” she says.
Infusions
Infusion treatments are administered by a healthcare professional regularly. These more recently approved drugs are monoclonal antibodies designed to prevent your immune system from attacking healthy tissues. Like injections, they can cause infusion-site reactions, but some of these drugs also raise your risk for other diseases down the line.
Ocrevus (ocrelizumab) This is the only drug approved to treat both RMS and PPMS. In addition to injection-site reactions, it can give you a fever or nausea and lower your blood pressure. It’s unclear, but possible, that Ocrevus may increase your risk of breast cancer.
Lemtrada (alemtuzumab) Alemtuzumab is a treatment usually reserved for those with very aggressive MS or those who don’t respond to other treatments. It must be administered by a registered provider, and it can heighten your risk for autoimmune disorders and infections. Two autoimmune disorders, immune thrombocytopenic purpura (ITP) and anti glomerular basement membrane disease, are especially dangerous. The former can cause severe bleeding and the latter, kidney failure. It can also increase your risk of strokes and certain cancers.
Tysabri (natalizumab) Along with weakening your immune system, natalizumab can damage your liver, raise the risk of herpes infection spreading to your nervous system and increase your risk for a rare and dangerous brain infection, progressive multifocal leukoencephalopathy (PML).
Oral Treatments
The oral treatments for MS come as pills taken regularly Many of them raise your risk for serious infections, liver problems and the rare brain infection PML.
Mavenclad (cladribine) Cladribine can raise your risk for heart failure and certain cancers and cause birth defects, if taken within six months of getting pregnant.
Tecfidera (dimethyl fumarate) Dimethyl fumarate can cause gastrointestinal discomfort and vomiting and also cause flu-like symptoms, difficulty urinating, and lower back and side pain and flushing.
Vumerity (diroximel fumarate) In addition to raising your risk of infections and PML, diroximel fumarate can cause flushing, itchiness and gastrointestinal issues.
Gilenya (fingolimod) A unique side effect of fingolimod is reduced blood pressure within the first several hours of taking the first dose. If you have irregular heartbeats or have had a heart attack or stroke recently, you should not take this drug. Other side effects of the MS drug are an increased risk of infections, blurry vision, headaches and higher blood pressure. It can also cause birth defects, if taken while pregnant, or if you conceive up to two months after stopping the treatment.
Zeposia (ozanimod) Ozanimod can interact with a type of antidepressant called monamine oxidase inhibitors (MAOIs), such as Nardil (phenelzine). You should also avoid this drug if you have sleep apnea. Ozanimod can lower your blood pressure, especially during the first eight days after you take it. Other side effects of the MS drug are lightheadedness, shortness of breath, fatigue, chest pain and confusion. Over time, it can also cause increased blood pressure, breathing problems, macular edema (a buildup of fluid in the eye that can damage vision) and narrowing of blood vessels in the brain that can lead to seizures or confusion.
Mayzent (siponimod) Siponimod can alter your blood pressure, so your physician may suggest monitoring you for hours after your first dose. It can also cause vision problems and birth defects for up to 10 days after taking your last dose.
Aubagio (teriflunomide) Teriflunomide can cause birth defects when taken by either men or women. Physicians recommend using contraception for up to two years after you stop taking the drug to avoid harming a fetus. If you do become pregnant, it’s important to tell your physician right away to discuss how you can get the drug out of your system quickly and safely. It can also cause severe blisters, breathing problems, high blood pressure, gastrointestinal distress and hair loss.
As-Needed Drugs to Combat Relapses and Flare-ups
Corticosteroids These drugs reduce inflammation during a flare-up and are commonly prescribed for a variety of conditions. They still come with side effects, such as increased appetite, upset stomach, swelling, mood changes and blurry vision.
Plasmapheresis Plasma exchange, also known as plasmapheresis, is usually a backup plan if you haven’t responded to corticosteroids. A healthcare provider will hook you up to a machine that gradually takes your blood, separates out the portion that contains the rogue antibodies attacking your healthy tissues and sends the blood back into your body. It can cause blood-clotting problems and infections.
The Role of Diet and Lifestyle in MS Management
There’s no known diet to help ease MS symptoms, but patients “can definitely benefit from a very healthy lifestyle,” says Yadav. That should include a diet that helps manage their weight and prevent cardiovascular disease and a regimen of regular exercise. “We have very convincing data,” she adds, that MS patients who don’t have comorbidities, like hypertension and diabetes, have slower disease progression than their counterparts with these conditions.
Avoiding or quitting smoking is important as well. In addition to contributing to comorbidities, it’s been shown that smoking can worsen MS.
Yadav says that exercise is extremely important to reducing the burden of the disease and maintaining your ability to walk, for example. Some MS patients struggle with exercise because it raises their body temperature, which can temporarily enhance symptoms. For these patients, swimming and water aerobics may be options in which they can keep cool and still get a healthy workout in.
Occupational therapy (OT) can be helpful for many patients as well, explains Brittany Ferri, PhD, a founder and occupational therapist at Simplicity of Health. “OT can provide adaptive equipment, which helps people walk more safely and complete basic self-care tasks independently despite their symptoms, strengthening exercises and balance training to help people better manage relapses.”
What Else Can You Do?
Many of the medications dampen your immune system, leaving you more vulnerable to infections. Washing your hands frequently and thoroughly can go a long way to preventing diseases that can be worse for you than for people without MS.
Lastly, Ferri suggests keeping a symptom diary and discussing what you noticed at doctor’s appointments. Keeping track of your symptoms can help you and your physician notice patterns that can suggest whether you need to adjust your dose or switch to a new medication, or if there are triggers in your daily life that you can avoid, like taking medicine on an empty stomach. The diary will also ensure you don’t forget a symptom that may or may not be related to your diagnosis.
When you see your doctor, it’s crucial to be “completely open about any symptom that you’re having. A lot of times people will say that everything that they have is due to MS,” says Yadav. That’s not necessarily true. However, even if a symptom is not related to your diagnosis, it could be impacting your treatment. Your healthcare provider should know about it.
“It is not your fault you received this diagnosis, but it is your responsibility to take care of yourself and look after your own health through diet and lifestyle changes and medication,” adds Hadge.
