Guidelines for initiating treatment of MS

What is Multiple Sclerosis (MS)? How will MS help my MS? What are the goals of MS treatment?

There are four main types of multiple sclerosis (MS), with relapsing-remitting multiple sclerosis (RRMS) being the most common. This is also the type that most people accept as a first-time diagnosis.

Currently, the U.S. Food and Drug Administration (FDA) approves 20 different drugs to prevent brain and spinal cord injuries that cause MS symptoms. These are often referred to as "disease-relieving drugs" because of their ability to slow the progression of MS.

When you start your first MS treatment, you should know a few things about RRMS medications, how they can help you, and the side effects they can cause.

Questions to ask the doctor

Before you go home with your new treatment plan, here are a few questions to ask your doctor:

• Why do you recommend this treatment?
• How will it help my MS?
• How do I accept it? How often do I need to take it?
• How much does it cost?
• Will my health insurance plan pay for it?
• What side effects will it cause and what should I do if I have them?
• What are my other treatment options and how do they compare to the ones you recommend?
• How long does it take for me to see results?
• What should I do if my treatment stops working?
• When is my next date?
• Are there any indications that I should call you between scheduled visits?

What are the treatment goals?

Each person's goals when starting treatment may be slightly different. In general, the goals of treatment of MS are:

• Reduce the number of recurrences
• Prevent injuries that lead to brain and spinal cord injuries
• Slows the progression of the disease

It's important to understand what your treatment can and can't do and to be realistic about your goals. Drugs that improve the disease can help reduce relapse, but they cannot completely prevent recurrence. When symptoms appear, you may need to take other medications to relieve symptoms.

Treatment of RRMS

Disease-modifying drugs can help slow the formation of new lesions in the brain and spinal cord, and they can also help reduce recurrence. It is important to start using one of these treatments as soon as possible after diagnosis and to stick to it for the time recommended by your doctor.

Early initiation of treatment from a trusted source has been found to help slow the progression of RRMS to secondary MS (SPMS). Over time, SPMS progressively worsens and can lead to more disabilities.

MS treatment to improve the disease includes injections, infusions, and pills.

Injectable drugs

• β-interferon (Avonex, Betaseron, Extavia, Plegridy, Rebif) [KW1] is injected every other day or every 14 days, depending on the exact treatment you prescribe. Side effects may include flu-like symptoms and injection site reactions (swelling, redness, pain).
• Copaxone acetate (Glatopa) is injected once a day or up to 3 times a week, depending on which medication you prescribe. Side effects may include injection site reactions.

Pill

• Mavenclad is a tablet that you can get in two courses once a year for 2 years. Each course consists of two 4 to 5-day cycles, one month apart. Side effects may include respiratory infections, headache, and low white blood cell count.
• Dimethyl fumarate (Tecfidera) is an oral treatment in which you first take 120 milligrams (mg) capsules twice daily for a week. After the first week of treatment, you take 240 mg capsules twice a day. Side effects may include skin flushing, nausea, diarrhea, and abdominal pain.
• Diroximel fumarate (Vumerity) starts with one 231 mg capsule twice daily for 1 week. Then you double the dose to two capsules twice a day. Side effects may include skin flushing, nausea, vomiting, diarrhea, and abdominal pain.
• Fingomod (Gilenya) is a capsule taken once a day. Side effects may include headaches, flu, diarrhea, and back or abdominal pain.
• The dose of simpomod (Mayzent) is gradually increased over 4 to 5 days. From there, you will take a maintenance dose once a day. Side effects may include headaches, high blood pressure, and liver problems.
• Teriflunomide (Aubagio) is a once-daily pill with side effects that can include headaches, thinning hair, diarrhea, and nausea.
• Zeposia (Ozanimod) is a once-daily pill whose side effects include an increased risk of infection and slowing of the heart rate.

Transfusion

• Alemtuzumab (Campath, Lemtrada) is an infusion once a day for 5 days. After one year, you receive three doses for 3 consecutive days. Side effects may include rash, headache, fever, nasal congestion, nausea, urinary tract infections, and fatigue. This medication is usually not prescribed to you until you have tried and failed the other two MS medications.
• Ocrelizumab (Ocrevus) is administered as the first dose, a second dose after 2 weeks, and then every 6 months. Side effects may include infusion reactions, an increased risk of infection, and a possible increased risk of certain types of cancer, including breast cancer.
• Novantrone is given every 3 months, with a maximum of 12 doses over 2 to 3 years. Side effects may include nausea, hair loss, upper respiratory tract infections, urinary tract infections, mouth ulcers, aberrations, diarrhea, and back pain. Because of these serious side effects, doctors usually leave the drug to people with increasingly severe RRMS.
• Natalizumab (Tysabri) is administered every 28 days in the infusion facility. In addition to side effects such as headache, fatigue, arthralgia, and infection, Tysabri may increase the risk of rare and potentially severe brain infections called progressive multifocal leukoencephalopathy (PML).

You will work with your doctor to develop a treatment plan based on the severity of your illness, your preferences, and other factors. The American Academy of Neurology recommends Lemtrada, Gilenya, or Tysabri for people who have experienced many serious relapses (so-called "hyperactive diseases").

If you do experience side effects, call your doctor for advice. Do not stop taking the drug without the approval of your doctor. Stopping the medication may lead to more relapses and neurological damage.

Takeaway

Today, there are many different medications available to treat MS. Starting one of these drugs immediately after the diagnosis can help slow the progression of MS and reduce the number of relapses.

It is important to be actively involved in your own care. Learn as much as you can about your treatment options so you can have a thoughtful discussion with your doctor.

Make sure you understand the potential benefits and risks of each medication. Ask what to do if the treatment you're receiving doesn't help or if it's causing side affects you can't stand.