Although there is no cure for multiple sclerosis (MS), treatment can help speed recovery from attacks, modify the course of disease and manage symptoms. Your neurologist will prescribe medicines to help you cope with specific symptoms and complications of MS.
These treatments are called ‘disease modifying therapies’ and don’t cure MS, but they can reduce how many and how serious your relapses are.
Steroids
Steroids are strong medicines that reduce inflammation and affect the immune system. They are similar to hormones that your adrenal glands (small glands above the kidneys) make to fight stress associated with illnesses and injuries. You can get steroids by mouth or as injections. You can also apply them to the skin as creams, ointments and drops.
Oral steroids can treat flare-ups in a number of chronic inflammatory conditions including rheumatoid arthritis, lupus, and inflammatory bowel diseases like Crohn’s and ulcerative colitis. They are also used to reduce autoimmune disorders, such as multiple sclerosis, and some allergic reactions.
If you are taking steroid tablets, it is important to keep up with your regular check-ups as they can cause a range of side effects, including weight gain and high blood pressure. This is why you need to watch what you eat and try to do some exercise. The long-term use of steroids can lead to weakened bones and cataracts. If you are taking steroid injections, it is important to take care when using the needle and not share them with anyone. This is because you could be at risk of getting HIV (human immunodeficiency virus), which causes AIDS, or hepatitis, a liver disease.
Depending on the type of steroid you are taking, the injections can be injected into the body either in the muscle or just under the skin. For steroid injections into the muscle, it is usually best to have them done by a doctor or a trained nurse. If you are having steroid injections into the eye or nose, it is recommended that you speak to an experienced ophthalmologist as they can give you advice on how to protect your eyes from infection whilst receiving steroid injections.
Steroids can have a range of psychological side effects. They may make you feel aggressive or combative, and can cause you to believe things that aren’t true (delusions). They can also increase your risk of having a heart attack or stroke. You can minimise these side effects by taking your medication for as short a time as possible, and following a healthy diet and lifestyle.
Plasmapheresis
Plasmapheresis is a treatment that removes unhealthy plasma from the blood and replaces it with healthy plasma or another fluid. Plasma is a fluid in the blood that contains platelets, red and white blood cells, and essential nutrients. The process is also known as apheresis, which refers to any medical procedure that separates and filters parts of the body’s blood.
Plasma exchange can be used to treat autoimmune diseases such as multiple sclerosis, Guillain-Barre syndrome, and myasthenia gravis. The procedure can reduce symptoms, such as muscle weakness or difficulty breathing. However, it is not a cure for these conditions and must be combined with other medications. Plasmapheresis is a safe and effective treatment, but it can cause side effects, including blood clots. Blood thinners, such as warfarin (Coumadin), Pradaxa (dabigatran), Xarelto (rivaroxaban), and Eliquis (apixaban) are often given before plasma exchange to reduce this risk.
The goal of plasmapheresis is to stop the body’s antibodies and immune cells from attacking the protective covering of nerves in the brain and spinal cord. In people with MS, these cells attack the myelin sheath and disrupt electrical impulses in the brain. Plasmapheresis can help prevent relapses and slow the progression of MS. It is also used to treat rare diseases such as Goodpasture syndrome and Wegner’s granulomatosis, and to prevent transplant rejection in people with blood-type incompatible kidney or liver transplants.
Plasmapheresis is usually done by a doctor or nurse in an outpatient clinic. The procedure can take several hours and requires monitoring by a health care professional. It is most effective when administered in combination with other immunosuppressive therapies. Plasmapheresis can cause serious complications, but they are rare and generally not life-threatening. Depending on the type of plasma being used as replacement fluid, plasmapheresis can also increase the risk of developing a blood clot in the legs or arms. These blood clots can be dangerous and may require surgery to treat. Plasmapheresis is generally covered by insurance for most conditions. However, the specifics of your coverage will vary by insurer. You should always discuss your specific coverage with your provider before undergoing the procedure.
Interferon beta agents
The first disease-modifying treatment to be developed for multiple sclerosis, interferon beta agents reduce the number and severity of MS relapses. These drugs work by altering the way your immune system functions at a number of levels, including changing the cytokine networks that influence inflammation. However, some people develop neutralizing antibodies to the drug, which can decrease its effectiveness. There are a number of different types of interferon beta drugs, including Rebif (interferon beta-1a), Avonex (interferon beta-1b) and Peginterferon beta-1A (Plegridy).
The type I interferons help the body stop attacks on itself by targeting inflammatory immune cells that cause damage to the myelin sheath that wraps nerve fibers in the brain and spinal cord. The drug’s long-term safety profile and efficacy have made it a standard of care for relapsing-remitting MS.
In clinical trials, the drug reduced the number of relapses by about one third and also helped slow the development of disability, compared to placebo (a dummy treatment). However, most patients do not experience this dramatic reduction in relapses or improvement in their MRI findings. In addition, some people develop flu-like symptoms and injection site reactions while taking interferon beta medications.
These medications are given by injection under the skin, usually every other day or once a week. They may be administered in the doctor’s office or at home. These drugs are most useful for those with relapsing-remitting or secondary progressive MS. They are not effective in treating primary progressive MS or progressive multifocal leukoencephalopathies.
Interferons are proteins produced naturally in the human body and released by white blood cells to change how your immune system responds to infections. They can also affect a number of other cells, including those that are involved in the production of myelin.
Interferons may be combined with other MS medications, such as corticosteroids or glatiramer acetate. The medications are injected under the skin or given by vein infusion (IV). They may be used as short-term therapy for severe symptoms, such as a relapse. They are also useful in treating a flare. Other short-term treatments for relapses include IV immunoglobulin therapy or plasma exchange.
Glatiramer acetate
Glatiramer acetate is a disease-modifying therapy for people with relapsing-remitting multiple sclerosis (RRMS). It works by depressing the immune system, which helps reduce inflammation and preserve nerve fibers in the brain and spinal cord. It also reduces the amount of gadolinium-enhancing lesions seen on MRI. The drug does this by binding to a specific type of T-cell receptor called MHC class II. This stops the T-cells from recognizing myelin and attacking it. It also increases the production of regulatory T-cells, which keep the immune system in balance.
It is one of the first approved drugs for RRMS, and it has proven to be effective in reducing relapses and new lesions on MRI scans. It also has a favorable safety profile and is relatively well tolerated over long-term use. It has also been shown to improve quality of life.
In a trial, patients with RRMS who took a high dosage of 40 mg of glatiramer acetate per day for nine months showed fewer new lesions on MRI than those who took placebo. These patients also had a lower rate of relapses and a better expanded disability status score on the Expanded Disability Status Scale.
This drug can be used alone or with other medications. It is most effective if you start taking it early on in the course of your illness. It is a little less effective than interferon beta, but it still significantly reduces relapses and slows down how fast your disease gets worse.
This medication is given by injection. It comes in prefilled syringes. Make sure you use each syringe only once and dispose of the empty syringe in a puncture-resistant container. It may cause a reaction right after you inject it, such as flushing, chest pain, pounding heartbeat, anxiety, difficulty breathing, closing of the throat, or hives. These symptoms usually last a few minutes and go away. If the symptoms are severe, call your doctor. You may also get a dent in the skin around the injection site, which is known as lipoatrophy. It is less common than other side effects of glatiramer acetate.
