Multiple sclerosis (MS) is a chronic autoimmune condition that leads to lesions on the central nervous system (the brain and spinal cord), causing symptoms related to movement, vision, and speech. Treatment is a complicated process and includes disease-modifying treatments (DMTs) that are approved or indicated for multiple sclerosis. Treatment may also involve drugs currently in clinical trials or off-label medications that are used to manage symptoms associated with MS. What does this all mean? Let’s explore how to make sense of these different drug types and treatment options.
DMTs are considered the best strategy currently available to slow the natural progression of multiple sclerosis. A DMT can also manage symptoms and relapses (also called exacerbations or clinical attacks).
DMTs are approved by the U.S. Food and Drug Administration (FDA). The FDA currently has approved the following DMT medications for the treatment of multiple sclerosis:
Some drugs are not yet FDA approved for the treatment of multiple sclerosis but are moving toward federal approval for treating MS. For instance, bazedoxifene has shown promise as a remyelinating agent in people with relapsing-remitting multiple sclerosis and is currently in phase 2 clinical testing. Multiple sclerosis is known for stripping the conductive sheath, called myelin, that surrounds nerve cells. Bazedoxifene may be able to restore that layer and improve communication within the central nervous system. The drugs clemastine and erythropoietin have also shown beneficial effects attributed to remyelination in phase 2 clinical trials. These are but a few of the drugs currently in the multiple sclerosis treatment pipeline.
Although drugs that have been approved for the treatment of multiple sclerosis are important in the fight against MS, sometimes DMTs are not enough. Often, other medications are used off-label to treat various symptoms.
Low-dose naltrexone has shown potential for off-label use as a pain medication due to its actions as an anti-inflammatory. Importantly, naltrexone has been clinically shown to improve pain symptoms and quality of life in individuals with multiple sclerosis. Low-dose naltrexone, particularly if taken at night, may sometimes have a side effect of sleep disturbances (such as nightmares or insomnia).
People with multiple sclerosis sometimes suffer from comorbid depression. Antidepressants may be used to help reduce the negative symptoms associated with depression in these individuals. Antidepressants also have many potential side effects, from changes in weight to fatigue.
To combat the symptom of fatigue or feeling tired, wakefulness-promoting drugs such as amphetamines (Adderall) are sometimes prescribed. Some of the most common side effects of Adderall include dizziness, headache, and nervousness or anxiety. Some practitioners also use modafinil (Provigil) to treat MS-related fatigue.
For MS-related issues in movement such as spasticity, tremors, and gait (walking) dysfunction, a doctor may consider prescribing clonazepam (Klonopin). Side effects of this drug can potentially include addiction. Dalfampridine (Ampyra) is also another medication that has been shown to improve ambulation in people with MS.
Sometimes, immunosuppressant drugs are also used to help treat multiple sclerosis. Again, these drugs are not approved by the FDA for the treatment of multiple sclerosis, but there is some science to support their use in reducing relapses. These drugs include mycophenolate mofetil (Cellcept), cyclophosphamide (Cytoxan), and azathioprine (Imuran).
Minocycline, an antibiotic, is also sometimes used to treat MS. Rituximab (Rituxan), an antibody that targets white blood cells, has additionally shown promise as a safe and efficient therapeutic tool.
Keep in mind that no matter which medication or combination of medications you or your loved one is prescribed, there are always side effects. These can vary greatly depending on the combination of medications involved. Symptoms should be managed as well as possible, but always with approval from a doctor or physician.
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