Multiple Sclerosis: What's New in Treatment Options?
What is Multiple Sclerosis?
The nerve damage that occurs with MS is not reversible, and MS is not curable. However, early treatment with medicine and lifestyle changes can make a positive impact on one's quality of life.
Are There Different Types of MS?
- Relapsing-Remitting MS (RRMS)
- Secondary-Progressive MS (SPMS)
- Primary-Progressive MS (PPMS)
- Progressive-Relapsing MS (PRMS)
Who Gets MS and Am I at Risk?
The general risk for developing MS is 1 in 750, but the risk in those with a strong family history is 1 in 40. Not everyone who gets MS develops severe symptoms; roughly 20 to 40% of patients with MS do not have significant disability 10 years after their diagnosis.
What's Involved with Diagnosis and Treatment of MS?
Treatment of MS involves three distinct components: treatment of the acute attack; prevention of future attacks; and treatment of symptoms such as bladder dysfunction or depression.
What is an MS Attack or Relapse?
You can tell you are having a flare up if MS symptoms get suddenly worse - for example, maybe your vision in one eye becomes blurred, or a numbness or tingling in your body may return. New symptoms can last days, weeks or months, but eventually subside in RRMS. Lack of rest, alcohol use, or hot weather can bring on flare-ups, so avoid these triggers.
Tell Me More About RRMS and Its Symptoms
Common symptoms include fatigue, weakness, numbness, vision problems, walking problems, bladder/bowel or sexual dysfunction, depression, and problems with thinking clearly. Less commonly, problems with speech, swallowing, or breathing may occur. The normal routines of daily life and work - and one's quality of life - can be interrupted.
What Treatment Options Are Available for RRMS?
Additional medications may be added to control symptoms such as pain, bladder or bowel problems, difficulty with movement, or depression. Symptoms of MS may come and go, but they can be managed with medications and rehabilitation. MS is not considered life-threatening as most people will live a normal life-span.
Interferon Beta: First Approved Therapy for MS
These drugs are given by injection, either by intramuscular or subcutaneous (under the skin) shots, and you can be taught to do this at home for convenience. In addition, some formulations come as a prefilled syringe or autoinjector pen, to ease administration. Injections are given as often as every other day to only once every two weeks, depending upon drug and dosing directions.
Other Interferon Beta Side Effects
Be sure to discuss possible treatment side effects and their frequency with your healthcare provider. Not every patient experiences the same side effects at the same frequency. Some reactions, like flu-like symptoms, may be more common just at the beginning of treatment.
Copaxone and Glatopa: Other Possible First Line Agents
Common side effects with glatiramer include: injection site reactions, flushing, chest pain, or post-injection reaction (anxiety, chest pain, heart palpitations, shortness of breath, throat constriction, flushing). Post injection side effects typically last 15-30 minutes, subside without treatment, and have no known long-term effects.
New Oral MS Medications
The following slides outline benefits and possible side effects with these newer oral agents.
Important Facts: Gilenya
Gilenya has been shown to cut relapses by 52% when compared in a one year study to using interferon beta-1a, and by 54% when compared to placebo over two years. In addition, at one year, 13% more patients on Gilenya were relapse-free when compared to interferon beta-1a. Gilenya has also been shown to slow disease progression and the number of brain lesions on an MRI. Gilenya is manufactured by Novartis.
Gilenya Side Effects
Important Facts: Aubagio
Aubagio Side Effects
Important Facts: Tecfidera
Tecfidera Side Effects
A simple blood test will be performed prior to treatment and regularly thereafter to monitor the white blood cell count. If a serious infection develops, the provider may withhold treatment until resolved. Tecfidera is taken orally two times a day and is manufactured by Biogen Idec.
Tysabri, Lemtrada and Zinbryta: For Advancing MS
Tysabri is given every 4 weeks by IV infusion, and can be associated with a rare, but often fatal brain disease known as progressive multifocal leukoencephalopathy (PML). Lemtrada has a unique dosing schedule of two annual IV infusion treatments, but contains a boxed warning for serious side effects: autoimmune conditions, infusion reactions, and risk of cancer. Zinbryta is given once monthly by self-injection but can have serious liver side effects. All 3 drugs require a REMS restricted access program.
For More Advanced MS: Other Options
Mitoxantrone also has the potential for other serious side effects such as acute myelogenous leukemia and serious infections.
Do Disease-Modifying Drugs Help With MS Symptoms?
For example, corticosteroids like oral prednisone or IV methylprednisolone (Solu-Medrol) may be used to reduce inflammation. Plasma exchange (plasmapheresis) has been used to treat severe symptoms in patients who do not respond to corticosteroids.
Ampyra is an oral potassium channel blocker from Acorda Therapeutics, Inc. approved in 2010. Ampyra (dalfampridine) is an MS medication shown to improve walking in those with MS, but you should not use this drug if you have a history of seizures or kidney disease. Ampyra, when given at doses greater than that recommended (10 milligrams twice a day), can cause seizures.
Investigational MS Agents on the Horizon
Ocrelizumab (Genentech, Inc.)
Ocrelizumab is a humanized monoclonal antibody designed to target CD20-positive B-cells, which are implicated in the inflammatory and neurodegenerative processes of multiple sclerosis. It is a slightly modified version of Genentech's Rituxan (rituximab), which faces market competition from biosimilars. In February 2016, ocrelizumab was granted Breakthrough Therapy designation from the FDA for primary-progressive multiple sclerosis.
Laquinimod (Teva Pharmaceutical Industries Ltd. and Active Biotech)
Laquinimod is an oral, CNS-active immunomodulator that combines anti-inflammatory and possibly neuroprotective effects. It is being studied for the treatment of relapsing-remitting multiple sclerosis (RRMS) and primary-progressive multiple sclerosis (PPMS).
More Investigational Agents
Ozanimod (Celgene Corporation)
Ozanimod is an oral selective sphingosine 1-phosphate (S1P) 1 and 5 receptor modulator which works by reducing white blood cell migration to areas of inflammation. It is being studied to reduce relapses and delay disability progression in patients with relapsing forms of multiple sclerosis. Gilenya (fingolimod) was the first approved sphingosine 1-phosphate receptor modulator. Other S1P receptor modulators in clinical development include Novartis' siponimod and Actelion's ponesimod.
Anti-LINGO-1 is an antibody which targets LINGO, a neurologic protein that is involved in the development of myelin. Anti-LINGO-1 is intended to stimulate regrowth of the myelin sheath, potentially allowing for the re-myelination and restoration of nerve communication in MS patients.
A Must: A Healthy Lifestyle for MS Patients
- Physical therapy
- Avoid extreme heat or cold
- Eat a healthy, balanced diet
- Don't smoke and avoid second-hand smoke
- Learn about your various medications
- Exercise regularly
- Reduce Stress
- Find emotional support
What About the Costs of MS Treatment?
Plus, don't forget to discuss your financial situation with your doctor and pharmacist who may have advice on medication cost-savings or new generic approvals.
How Do You Determine Which Treatment is Right?
Over time, you will want to continue these discussions with your healthcare provider as your condition and treatments evolve. Each person responds to MS treatments in different ways, so a personalized approach is the best way to forge a positive outcome.
While you and your doctor should only direct your medical treatment, consider joining the Drugs.com MS Support Group to ask questions, express concerns, and keep up with the latest news.
Finished: Multiple Sclerosis: What's New in Treatment Options?
- American Academy of Neurology. Understanding Multiple Sclerosis. Accessed June 19, 2016 at https://www.aan.com/uploadedFiles/Website_Library_Assets/Documents/3.Practice_Management/5.Patient_Resources/1.For_Your_Patient/1.AAN_Patient_Education_Brochures/MS.pdf
- MS Drug Tied to Higher Risk for Potentially Deadly Brain Virus. Drugs.com. Jan. 27, 2016. Accessed June 19, 2016 at https://www.drugs.com/news/ms-tied-higher-risk-potentially-deadly-brain-virus-59903.html
- Stavnitser A, Patel P, Miller A, et al. Impact of New Oral Therapies on Multiple Sclerosis Cost and Utilization Trends. AJMC.com Managed MarketsNetwork. Feb. 7, 2013. http://www.ajmc.com/publications/ajpb/2013/ajpb_janfeb2013/impact-of-new-oral-therapies-on-multiple-sclerosis-cost-and-utilization-trends/1
- Pollack A. 3rd Oral Drug to Treat MS Is Approved by the F.D.A. The New York Times. Business Day. March 27, 2013. http://www.nytimes.com/2013/03/28/business/3rd-oral-drug-to-treat-ms-is-approved-by-the-fda.html?_r=1
- Kappos L, Ernst-Wilhelm R, O'Connor P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010;362:387-401.
- Could High-Dose Vitamin D Help Fight Multiple Sclerosis? Drugs.com. Dec. 30, 2015. Accessed June 19, 2016 at https://www.drugs.com/news/could-vitamin-d-help-fight-multiple-sclerosis-59569.html
- Holland K. Risk and Rewards of Treating Multiple Sclerosis. Drugs.com. http://www.drugs.com/health/multiple-sclerosis/risks-rewards-176/#1
- O'Connor P, Wolinsky JS, Confavreux C, et al. TEMSO Trial Group. Randomized trial of oral teriflunomide for relapsing multiple sclerosis. NEJM 2011;365:1293-303
- Fox RJ, Miller DH, Phillips JT, et al. CONFIRM Study Investigators. Placebo-controlled phase 3 study of oral BG-12 or glatiramer in multiple sclerosis. NEJM 2012;367:1087-97
- Genzyme. U.S. Prescribing Information. Aubagio (teriflumomide). September 2012 https://www.aubagio.com/
- Norvartis. U.S. Prescribing Information. Gilenya (fingolimod). May 2012 https:// http://www.gilenya.com/index.jsp/
- Biogen Idec. U.S. Prescribing Information. Tecfidera (dimethyl fumarate). May 2012 https:// http://www.tecfidera.com/
- National Multiple Sclerosis Society. About MS. http://www.nationalmssociety.org/about-multiple-sclerosis/index.aspx