MS Infusion Treatments: Your Guide

Treatment for multiple sclerosis (MS) has improved over the past decade, and there are now multiple medications that the U.S. Food and Drug Administration (FDA) has approved to slow disease progression, treat relapses, and manage symptoms caused directly or indirectly by MS. Depending on the MS medication prescribed, you may be taking them orally, as injections, or intravenously as infusions.

Infusion treatments entail delivering medication from a controlled infusion pump directly into your bloodstream through an IV, inserted either in your hand or arm. Infusion treatments can be administered at a clinic, infusion center, hospital, or at home with the help of a licensed health care provider.

MS infusion treatments are considered a long-term disease-modifying therapy (DMT) used to manage:

• Relapsing-remitting multiple sclerosis (RRMS)
• Secondary-progressive multiple sclerosis (SPMS)
• In some cases, primary progressive MS (PPMS)

Infusion treatments with corticosteroids may also be used to control a flare-up or relapse caused by nerve inflammation.

A MyMSTeam member talked about their experience with infusion treatments. “I had my second half of my first Ocrevus infusion,” they wrote. “My head has been so clear and I can't get over the difference. My brain fog is gone and my energy level has improved a lot, too. I hope this is my new normal.”

Benefits and Risks of MS Infusion Medications

Experts have found that early treatment of MS can help slow and stabilize disease progression and reduce exacerbations. Although infusion treatments are highly effective in people with active MS, there are also risks involved that your health care team will have to consider.

Benefits of Infusion Medications

For people with active MS, DMT infusion therapy is considered highly effective in slowing disease progression and preventing flare-ups and symptoms.

MS infusion therapy can relieve symptoms for longer periods of time than some other medications, and it can reduce the severity and length of relapse episodes. DMT infusion therapy can also slow the development of brain lesions found on an MRI scan.

Risks of Infusion Medications

Although the benefits of infusion therapy for treating MS are promising, infusion treatment isn’t right for everyone. Infusion medication can put some people at a higher risk for infection, a compromised immune system, and severe infusion reactions.

Risks associated with infusion medications prescribed to treat MS may include:

• Progressive multifocal leukoencephalopathy (PML), a serious brain infection
• Elevated liver enzymes
• Immunosuppression, which increases the risk of various infections and illness
• Herpes virus infection
• Infusion reactions
• Hepatitis-B virus reactivation
• Potential harm to an unborn baby
• Heart disease
• Leukemia

Infusion Medications and Side Effects

There are currently four infusion therapy drugs approved by the FDA used to treat MS as disease-modifying agents. Each medication comes with its own benefits and side effects.

Mitoxantrone

Mitoxantrone, sold as the brand name Novantrone, was the first long-term drug to treat RRMS and SPMS. Now, however, it is prescribed less often for treating MS because it can increase one’s risk of developing cardiac disease and leukemia. It is given once every three months.

Side effects of mitoxantrone can include:

• Heart disease
• Secondary leukemia
• Allergic reaction

Alemtuzumab

Alemtuzumab, sold as Lemtrada, has been approved as a second-line MS therapy, meaning that it typically will be prescribed only if the person does not respond well to other first-line treatments. It is given over a course of five days, followed by another three-day round a year later.

Side effects of alemtuzumab can include:

• Allergic reaction
• Increased risk of infection
• Other autoimmune diseases

Because of its risks, alemtuzumab is only available through a restricted distribution program. The program helps ensure the safety and monitoring of people taking the drug.

Natalizumab

Natalizumab, sold under the brand name Tysabri, is administered every four weeks. It was taken off the market for a period of time because it was associated with a serious risk of developing PML, a viral infection of the brain that can be fatal. Natalizumab was reapproved after experts identified key risk factors for developing PML, which doctors can screen for prior to prescribing the medication.

Side effects of natalizumab can include:

• Allergic reaction
• PML
• Headache
• Fatigue
• Urinary tract infection
• Respiratory infection

Ocrelizumab

Ocrelizumab, branded as Ocrevus, is the most recent infusion drug approved for the treatment of MS, and is given every six months. It is also the first medication approved to treat PPMS — and the first monoclonal antibody approved for MS that targets B cells, a type of immune cell. Most other medications target T cells, another type of immune cell involved in MS.

Side effects of ocrelizumab can include:

• Allergic reactions
• Increased infections
• PML
• Cancer

Testing Before Infusion Treatment

Before an infusion is administered, you will likely undergo a series of lab tests to ensure the medication is safe for you. Depending on the medication prescribed, these baseline tests may include:

• Screening for vaccinations against varicella zoster (shingles) and hepatitis A, B, and C
• COVID-19 test
• Measure of John Cunningham (JC) virus titer to see if you have been exposed
• Tests for tuberculosis
• Blood pressure test
• Complete blood cell count (or CBC) to check white blood cell levels
• Liver function test
• Urinalysis (kidney function test)
• Heart function test

What To Expect at an Infusion Center

Many people being treated for MS with infusion medications go to infusion centers to receive their medication. An infusion center can be located in a hospital, clinic, doctor’s office, or pharmacy.

Since infusion treatments can take several hours, the licensed staff will typically try to make you as comfortable as possible by providing items such as blankets, pillows, Wi-Fi, beverages, and other amenities. The infusion can be paused if you need to use the restroom.

To prepare for your time at an infusion center, consider bringing items that can help you pass the time comfortably. You may want to:

• Wear comfortable clothes
• Clear your schedule
• Bring a book
• Bring a loved one to keep you company
• Bring food or snacks
• Bring a tablet or other electronic device to watch videos, listen to a podcast or music, or play games

The goal of infusion therapy is to make you feel better, slow disease progression, and reduce symptoms and flare-ups, but you may leave the center feeling tired and weak.

A MyMSTeam member taking Ocrevus said, “I'm so very tired. I had my fifth Ocrevus infusion this past week. I don't remember feeling like this after my last infusions. Constant headaches and fatigue.”

Another member said that, after an infusion treatment session, they “tend to have a Benadryl hangover the rest of the day and the next day. Other than that, I'm good.”

It is important that you take the time to rest in a relaxing environment after your treatment to let your body recover.

Talk With Others Who Understand

MyMSTeam is the social network for people living with MS and their loved ones. By joining, you gain a community of over 167,000 people who come together to ask questions, give advice, and share their experience living with MS.

Have you received infusion therapy to treat your MS? Share your experience in the comments below or on MyMSTeam. Your story may help others learn more about what to expect from visiting an infusion center.