Finding the Right Drug to Slow Down MS


Chris Iliades, MD

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Prescriptions drugs

Getting a diagnosis of multiple sclerosis (MS) is a life-changing experience. However, there have been major breakthroughs in MS treatment: In 1993, the U.S. Food and Drug Administration (FDA) approved the first medication that can actually slow down the progression of the disease. Before that, doctors could only treat MS symptoms. There are now ten of these disease-modifying drugs.

Disease-modifying drugs can reduce the frequency of MS attacks, reduce damage to the brain and spinal cord, and reduce the chances of becoming disabled. There is a disease-modifying drug for every type of MS except primary progressive MS, a rare form of MS that does not have periods of remission.

MS is caused by an abnormal immune system (your body's defense system), which means your body mistakenly targets the tissues of your brain and spinal cord. Immune system cells cross into your central nervous system and attack the myelin, or protective lining around nerves. Over time the myelin sheaths around your nerves deteriorate and become scarred, and nerve signals become blocked or distorted. Disease-modifying drugs work by interfering with this abnormal immune system response.

Disease-modifying drugs are the best treatment available for MS. The one you'll take depends on your level of disease, your response to the drug, and your side effects. (You can't take any of the drugs if you are pregnant or planning to become pregnant.) You may choose one drug over another based on how the drug is given and its known risk factors. This is a decision you will need to make with your MS healthcare provider. Here's a look at the ten approved drugs.

Betaseron (interferon beta-1b) was the first drug approved for MS, in 1993. Interferon drugs are proteins that alter the immune system. This drug is given by injection under the skin every other day. Betaseron is approved for people who are newly diagnosed with MS and for people who have relapsing MS. If you use this drug, you will need to inject yourself or have someone inject you at bedtime. The drug comes in a preloaded syringe. Flu-like symptoms are common after the injection. These symptoms may be reduced over time as you continue to use the drug. Taking over-the-counter pain relief, like Tylenol or Advil, at the time of your injection may lessen this reaction. You can also have skin reactions at the injection site, so you will need to rotate the areas of injection. Liver abnormalities, depression, low white blood cell counts, and allergic reactions are less common risk factors.

Avonex (interferon beta-1a) is an interferon drug that was approved for MS in 1996. Avonex is injected into a muscle once a week. Avonex is used to treat newly diagnosed and relapsing MS. This drug also comes in a preloaded syringe to be injected at bedtime. Avonex causes flu-like symptoms after injection. Less common side effects are depression, liver abnormalities, allergic reactions, and heart problems.

Rebif (interferon beta-1a) was approved in 2002 and is injected under the skin three times a week. It is approved for people with relapsing forms of MS. Side effects are similar to Betaseron.

Extavia (interferon beta-1b) is the most recently approved interferon drug. It is given by injection under the skin every other day. It is approved for new and relapsing MS. Side effects are similar to Betaseron.

Copaxone (glatiramer acetate) was approved in 1996. It is given by injection under the skin every day. Copaxone is not an interferon drug. It works by blocking the damage MS does to myelin nerve sheaths. Copaxone can be used to treat new or relapsing cases of MS. It can cause a reaction at the injection site, so these areas need to be rotated. Uncommon side effects are chest pain, anxiety, and flushing.

Novantrone (mitoxantrone) is an anticancer drug that works against MS by suppressing immune system cells. It is a drug with serious side effects and is only used for worsening relapsing or relapsing and progressing MS. It is given four times per year as an intravenous infusion (given directly into your vein at a medical facility). It was approved in 2000. It can only be used for two to three years. Side effects include fatigue, bruising, infections, hair thinning, and nausea. Serious liver damage and heart damage are possible.

Medical Reviewers: William C. Lloyd, MD, FACS Last Review Date: Nov 21, 2013

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