Understanding MS treatment types

Understanding MS treatment types

Every person living with multiple sclerosis (MS) experiences the condition differently, and what you want to get from your treatment and your life with MS will most likely differ to others living with the condition. Which is why it’s great that there are now so many different treatment options available to choose from. In order to find the right one for you, it’s essential that you talk to your doctor or MS nurse. They’ll be able to provide plenty of information about the different options available, and will work with you to ensure you’re managing your MS in the best way possible for you.

To help you to prepare for these conversations, here’s some information that may help you to understand your options better.

    Broadly speaking, treatments for MS have one of two intentions – to manage symptoms or to reduce disease progression:

    • Managing symptoms – treatments that directly improve symptoms can aid recovery from a relapse and help with general day-to-day management of the condition. However, they don’t prevent further damage to the central nervous system (CNS) or change how the disease will progress over time
    • Reducing disease progression – this is achieved using disease modifying treatments (DMTs) that target the underlying MS process. It’s unlikely that treatment with DMTs will make you feel better straight away, but they can help to protect your brain against future damage, reduce the number and severity of relapses, reduce disability and help you stay able for longer

    Disease modifying therapies (DMTs) are a group of treatments for MS that aim to treat the underlying disease, not just the symptoms of the condition, and when taken as prescribed may slow or potentially prevent the damage MS is causing to your central nervous system (CNS).

    A number of DMTs are now available, and it’s a good idea to spend some time with your doctor or MS nurse discussing how they differ. It’s important you take your prescribed DMT to protect your future quality of life and limit the impact of MS on your lifestyle and personal goals.

    But remember that treatments don’t work the same for everyone: that’s why it’s important for you and your doctor or MS nurse to keep track of how well they’re working.

    If you are looking for advice on how to approach the first conversation you have with your neurologist about your treatment options, explore discussing treatment with your neurologist.

    There are several different DMTs for the treatment of multiple sclerosis, the vast majority of which are for relapsing remitting MS (RRMS). Your doctor or MS nurse can tell you more about your different options, but the table below gives an overview of those currently available. Like most treatments, DMTs for MS have two names. The brand name is the name given by the pharmaceutical company that makes the treatment. The generic name is the term given to the active ingredient in the treatment, which is uniform and understood globally.

    Brand name

    Generic name

    Dosing

    Aubagio®

    teriflunomide

    14 mg film-coated tablets taken once daily

    Avonex®

    interferon beta-1a

    30 mcg/0.5 ml solution for injection administered once weekly

    Betaferon®

    interferon beta-1b

    250 mcg/ml, powder and solvent for solution for injection administered every other day

    Brabio®

    glatiramer acetate

    20 mg/ml or 40 mg/ml solution for injection administered three times a week and at least 48 hours apart

    Copaxone®

    glatiramer acetate

    20 mg/ml or 40 mg/ml solution for injection administered once daily

    Extavia®

    interferon beta-1b

    250 mcg/ml powder and solvent for solution for injection administered every other day

    Gilenya®

    fingolimod

    0.5 mg hard capsules taken once daily

    Lemtrada®

    alemtuzumab

    12 mg concentrate for solution for infusion administered in 2 treatment courses, lasting 5 days and 3 days respectively, and given 12 months apart

    Mavenclad®

    cladribine

    The 2 treatment courses for Mavenclad are over a 2-year period (one week in the beginning of the first and second months, each year). Each treatment course lasts 2 weeks, and consists of treatment with 10 mg or 20 mg as a single daily dose for 4 or 5 days in each week. Dosing is dependent on body weight

    Mayzent®

    siponimod

    2 mg film-coated tablet taken once daily following treatment initiation. Treatment initiation: increasing dosage for the first 6 days of treatment, starting with 0.25 mg on day 1, reaching a 2 mg maintenance dose on day 6

    Novantrone®

    mitoxantrone

    2 mg/ml concentrate for solution for infusion administered as an infusion at a dose of 14 mg/m2 body surface, which may be repeated at 21-day intervals (dosing may vary as per local regulation)

    Ocrevus®

    ocrelizumab

    300 mg concentrate for solution for infusion. First dose of 600 mg is administered in 2 treatment courses of 300 mg given 2 weeks apart. Subsequent doses of 600 mg administered as a single infusion every 6 months

    Plegridy®

    peginterferon beta-1a

    125 mcg solution for injection administered every 2 weeks

    Rebif®

    interferon beta-1a

    22/44 mcg solution for injection administered three times per week

    Tecfidera®

    dimethyl fumarate

    Starting dose is 120 mg twice daily for 7 days, after which the dose is increased to 240 mg gastro-resistant hard capsules taken twice daily

    Tysabri®

    natalizumab

    300 mg concentrate for solution for infusion administered once every 4 weeks

    There are three different ways that DMTs for MS can be taken: via injection, orally or through direct delivery into a vein during an infusion.

    Injectables

    Injectables comprise the largest group of DMTs and are self-administered on a regular basis following training from a medical professional. In some instances, the use of injectable treatments can be associated with mild reactions at the injection site. If you do experience any of these reactions, you should discuss them with your doctor or MS nurse as soon as possible, to ensure that this is the most suitable treatment available for you.

    Orals

    Orals are DMTs in the form of a tablet or capsule that are taken once or twice a day. As orals are taken like any other tablet, they are considered the easiest to self-administer, but could require a more regular dosing schedule than injectable medications.

    Infusions

    Some DMTs are delivered directly into a vein through infusions. The exact detail of treatment courses depend on the drug, but all infusions are given in a clinical setting. Doses are administered significantly less often than injectable or oral MS medication. DMTs delivered by infusion are often those considered to be ‘high efficacy’, however, there is often a higher risk of serious side effects with these DMTs. Weighing up the benefits and risks of these therapies is something that should be done with your neurologist.

    Alternative therapies are treatments which aim to purely alleviate symptoms. Alternative therapies include:

    • Exercise
    • Meditation
    • Acupuncture
    • Herbal remedies
    • Changes in diet


    Although described as ‘alternative’, it’s important to remember that these aren’t to be used in place of treatments prescribed by your doctor. They should instead be considered ‘complementary’ therapies that can potentially be used alongside your normal DMT. Always consult with your neurologist beforehand if you are considering additional treatment with alternative therapies.

If you’re unsure whether you’re currently on a treatment plan that best matches your goals and lifestyle, it’s important that you talk to your neurologist, as there may be a different option out there that’s a better fit for you. Read our advice on how to approach discussing treatment with your neurologist.


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