Overview: What are Disease Modifying Therapies?

Presently no cure exists for multiple sclerosis and thus it is considered a chronic disease.

Disease-modifying medications attempt to alter the course of the disease to lessen or stop disease activity and progression.  Multiple sclerosis requires a comprehensive individualized care regimen for best case outcome prospects, comfort, and quality of life.

On the internet, you may see disease modifying medications called “Disease Modifying Therapies (DMTs)” or “Disease Modifying Drugs (DMDs)“. Both of these refer to the same medications that attempt to lessen disease activity.

How do Disease Modifying Therapies Work?

Currently, there are 14 DMTs approved for multiple sclerosis treatment by the United States Federal Drug Administration (FDA).  Some of these treatments may or may not be available within the country where you live.  You can discuss which are available with your health care provider.

The mechanisms of how the various treatments actually work differ and in some respects are unknown.  All the medications have gone through rigorous vetting processes known as clinical trials.  These clinical trials have the medications tested with people who endure life with multiple sclerosis for efficacy (effectiveness), side effects and often other aspects of the medication usage.  The data that results from the clinical trials is reviewed by governing authorities and either approved or disapproved for market approval and clinical usage for patients.

In multiple sclerosis, a person’s immune system attacks cells in the central nervous system which comprises the brain, spinal cord and optic nerves.  Disease modifying therapies attempt to limit these attacks called exacerbations.  You will often see exacerbations called “MS Attacks, Flare-Up’s, Relapses or, Disease Activity” in research or reading materials.

Our immune systems when functioning normally work to fight off invaders such as viruses, bacteria, and other antigens within our bodies. In multiple sclerosis the immune system attacks nerve cells in the central nervous system.

Essentially all the DMTs attempt to stop immune cells known or thought to be involved in exacerbations via their mechanisms of action. Some attempt stop cell replication, some try sequester cells, some destroy immune cells known to take part in attacks.

The Therapies:

Currently, all medication therapies that exist are purposed for relapsing-remitting multiple sclerosis (RRMS) which is the most common form of MS.  Medications for secondary progressive MS and primary progressive MS are currently in clinical trials.

Side Effects of Multiple Sclerosis Medication Therapies:

DMT ImageAll medications have side effects though we may or may not notice them. Even aspirin has side effects.  The range of side effects for MS medications varies quite widely and it is important to discuss them with your health care team.  Some side effects are quite mild and others can be severe. Side effects can cause a patient to not take or skip treatments.  Compliance in getting treatments is mandatory towards managing the disease course. Skipping dosing can negate efficacy of the medications.

If you cannot stay compliant in taking a given medication therapy then a discussion should take place with your health care provider to either consider a differing disease modifying therapy or ways to lessen or eliminate the side effect impacts of your current MS therapy. Many options do exist to help manage side effects of treatments.

Lastly, when researching and discussing  the therapy options with your care provider and family understand that side effects may or may not occur. Just because a therapy notes a known side effect that does not mean you will experience it.

Currently Available Therapies (US FDA Approved)

Below are the multiple sclerosis medications currently approved by the US Federal Drug Administration for usage as MS disease modifying therapies. If you do not live in the USA please check with your health care provider which medications are available to you.

Relapsing-Remitting MS Disease-Modifying Medications:

Injectable medications:

Avonex (interferon beta-1a)
Betaseron (interferon beta-1b)
Copaxone (glatiramer acetate)
Extavia (interferon beta-1b)
Glatopa (glatiramer acetate — generic equivalent of Copaxone 20mg dose
Plegridy (peginterferon beta-1a)
Rebif (interferon beta-1a)
Zinbryta (daclizumab)

Oral medications:

Aubagio (teriflunomide)
Gilenya (fingolimod)
Tecfidera (dimethyl fumarate)

Infused medications:

Lemtrada (alemtuzumab)
Novantrone (mitoxantrone)
Ocrevus (Ocrelizumab)
Tysabri (natalizumab)

Selecting the Right Disease Modifying Therapy:

Presently approved treatment options only are available for relapsing-remitting multiple sclerosis (RRMS).  Numerous medications are being developed and tested for other forms of the disease.  Some health care providers may recommend for secondary progressive MS (SPMS) or primary progressive MS (PPMS) an off-label medication. Off-Label medications have not been approved for multiple sclerosis treatment but have evidence that they may impact the course of the disease in a positive way.

Choosing which medication to use is complex and should be discussed thoroughly with your care provider.  Optimally, this discussion should address several aspects of both the course of your MS and other criteria.

An example of such a discussion might include:

  • How aggressive your MS appears to be.
  • What medications may be most effective in altering your disease course.
  • Which medications might be best tolerated by you.
  • Staying compliant in using the medication as prescribed.
  • Frequency by which medication is delivered.
  • Side effects of the medication choices presented to you.
    • Minimal side effects
    • Moderate side effects
    • Severe side effects
  • Impacts upon other medical conditions you might have.
  • Usage of medication options presented in conjunction with current medications you might take.
  • Financial ability to afford medication options and any assistance services available.
  • Pregnancy or considerations of having a child.
  • How the medication choices presented to you are thought to work.
  • Risk of PML (Progressive multifocal leukoencephalopathy) which is a risk with some therapies. PML is a highly destructive brain infection. PML has been associated with Tysabri, Tecfidera and Gilenya.
  • Follow-up tests to measure effectiveness of the selected medication and risk reductions.

Your neurologist optimally should also specialize in managing multiple sclerosis.  Multiple Sclerosis centers if available are often the best point of care for managing the disease.

If your neurologist simply sends you away with a handful of brochures it is probably a good time to start looking for another neurologist. As a patient, you are relying upon your neurologist to help you manage the disease.  Selecting your treatment options is not only important but may well be critical in managing your disease course.  Remember, you are the customer.  Do not be afraid to seek another neurologist if you feel that you are not being properly managed.

Optimally your neurologist should suggest which treatments he or she feels are best for your MS and why.

Every pharmacological company that produces disease modifying therapies has a support system in place that you can contact for help with the medication you are prescribed. Make sure you are aware of it and have their contact information available to you at all times.

Notes of Caution:

Be *Very Careful* of advice from other patients in respect to what they do to manage their MS. Multiple sclerosis is a highly complex disease.  Everyone’s multiple sclerosis differs in its impact on the patient in many differing ways.  Patient to patient advice should ALWAYS be discussed with your care provider before changing anything in your management of multiple sclerosis.  This includes things such as major dietary, lifestyle or over the country health supplements.

ANY information you locate in respect to MS that you are interested in engaging towards your management of multiple sclerosis should *ALWAYS* be discussed with your health care provider before making ANY changes in your life.

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List of FDA Approved Therapies:

Medication
Name
Generic
Name
Dose
Frequency
Dosage Delivery Product
Website
Year
Approved
Manufacturer
Website
Aubagio ® Teriflunomide Once Daily 7mg or 14mg Oral Pill www.aubagio.com 2012 www.genzyme.com
Avonex ® Interferon Beta-1a Once Weekly 30mcg Injection
(intramuscular)
www.avonex.com 1996 www.biogen.com
Betaseron ® Interferon Beta-1b Every Other Day 250mcg Injection
(subcutaneous)
www.betaseron.com 1993 pharma.bayer.com
Copaxone ® Glatiramer Acetate Once Daily
or
Three Times Weekly
20,000 mcg
or
40,000 mcg
Injection
(subcutaneous)
www.copaxone.com 1996 www.tevausa.com
Extavia ® Interferon Beta-1b Every Other Day 250mcg Injection
(subcutaneous)
www.extavia.com 2009 www.us.novartis.com
Gilenya ® Fingolimod Every Other Day 0.5 mg Oral Capsule www.gilenya.com 2010 www.us.novartis.com
Lemtrada ™ Alemtuzumab Five Consecutive Days
One Year Later:
Three consecutive Days
12mg Intravenous Infusion www.lemtrada.com 2014 www.genzyme.com
Novantrone ® Mitoxantrone Four Times Per Year
Dose Limit of 8–12
Doses Over 2–3 Years
140 mg/m2 Intravenous Infusion 2000 www.emdserono.com
Plegridy ™ Pegylated Interferon Beta-1a Every 14 Days (2 weeks) 125mcg Injection
(subcutaneous)
www.plegridy.com 2014 www.biogen.com
Rebif ® Interferon Beta-1a Three Times Weekly 44mcg Injection
(subcutaneous)
www.rebif.com 2002 www.emdserono.comwww.pfizer.com
Tecfidera ® Dimethyl Fumarate / BG-12 Twice Daily
120mg For First Week
240mg Thereafter
120mg/240mg Oral Capsule www.tecfidera.com 2013 www.biogen.com
Tysabri ® Natalizumab Every 4 weeks 300mg Intravenous Infusion www.tysabri.com 2006 www.biogen.com