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As of 2024, more than 20 different DMTs have been approved by the U.S. Food and Drug Administration (FDA) for treating relapsing MS. Research has proved that DMTs can reduce the frequency of clinical attacks (also called relapses, flare-ups, or exacerbations) and the development of new brain lesions and spinal cord damage. Some DMTs have also been shown to slow the accumulation of disability.
Overall, DMTs slow disease progression and might help keep relapsing MS stable. Relapsing forms of MS include clinically isolated syndrome, relapsing-remitting multiple sclerosis (RRMS), and active secondary progressive MS (SPMS).
With so many treatment options, how can someone diagnosed with relapsing MS know which MS treatment will be best for them? For some people, how a DMT is taken and how often it is taken are important factors — especially considering DMTs are taken long term, usually for years. Some prefer a medication taken orally over one taken by injection or intravenous infusion. Others prefer a more convenient dosage schedule with medication taken only a few times a year. It can also help to know how different classes of DMTs work.
Read on to find out which DMTs are prescribed for relapsing forms of MS, how each is taken, and what may lead doctors to recommend one over another.
All medications, even those sold over the counter, have potential side effects. Treatments for relapsing MS are no different, and each has possible risks.
Some side effects are more common, and others are extremely rare. Risk-averse people may prefer to avoid DMTs with a potential for serious side effects, even if those side effects occur very rarely. Others may prefer to focus on which DMT will be most effective in modifying the course of their MS, even if they carry a low risk for severe adverse effects.
Some DMTs have contraindications — circumstances that raise the risk for serious side effects for people who have other health conditions in addition to MS. For instance:
Your personal risk for developing serious side effects depends on many factors. Your doctor can help you understand your risk for side effects with any medication. If you have any other health problems or conditions, your doctor may avoid prescribing certain DMTs.
Doctors may recommend DMTs based on many factors. One important factor is MS disease activity. An individual’s MS may be active or inactive. Active disease means having a clinical relapse or detecting new lesions on an MRI scan over a period of time, usually a year.
When your MS is active, you’re more likely to experience new damage to the central nervous system. Doctors may suggest different DMTs based on whether your MS is considered to be active or inactive.
According to the Consortium of Multiple Sclerosis Centers (CMSC), a large organization of healthcare providers for those with MS, any approved DMT may be considered as the first treatment for someone diagnosed with a relapsing type of MS. The choice should be based on what is best for the individual. Your doctor will help you decide on the treatment that works best for your needs and symptoms.
The following DMTs have been approved by the FDA to treat relapsing forms of MS.
| DMTs for Relapsing Forms of Multiple Sclerosis | ||
| Disease-modifying treatment | How it’s taken | Dosage schedule |
| Alemtuzumab (Lemtrada) | IV infusion | Five days in a row, then three days one year later |
| Cladribine (Mavenclad) | Oral | 10 pills in year one, 10 pills in year two |
| Dimethyl fumarate (Tecfidera) | Oral | Twice a day |
| Diroximel fumarate (Vumerity) | Oral | Twice a day |
| Fingolimod (Gilenya) | Oral | Once a day |
| Glatiramer acetate (Copaxone) | Injection | Daily or three times a week |
| Interferon beta-1a (Avonex) | Injection | Once a week |
| Interferon beta-1a (Rebif) | Injection | Three times a week |
| Interferon beta-1b (Betaseron) | Injection | Every other day |
| Interferon beta-1b (Extavia) | Injection | Every other day |
| Monomethyl fumarate (Bafiertam) | Oral | Twice a day |
| Natalizumab (Tysabri) | IV infusion | Monthly |
| Ocrelizumab (Ocrevus) | IV infusion | Every six months |
| Ocrelizumab and hyaluronidase-ocsq (Ocrevus Zunovo)* | Injection | Twice a year |
| Ofatumumab (Kesimpta) | Injection | Monthly |
| Ozanimod (Zeposia) | Oral | Once a day |
| Peginterferon beta-1a (Plegridy) | Injection | Every two weeks |
| Ponesimod (Ponvory) | Oral | Once a day |
| Siponimod (Mayzent) | Oral | Once a day |
| Teriflunomide (Aubagio) | Oral | Once a day |
| Ublituximab (Briumvi) | IV infusion | 2.5-hour IV infusion every six months |
| Based on information sourced from “Treatment for MS” provided by MS Focus at https://msfocus.org/Get-Educated/Treatment-for-MS.aspx *Based on information sourced from “FDA Approves Ocrevus Zunovo (Ocrelizumab & Hyaluronidase-Ocsq), Similar to Ocrevus” provided by National Multiple Sclerosis Society at https://www.nationalmssociety.org/news-and-magazine/news/fda-approves-ocrevus-zunovo | ||
Remember that no DMT can cure or completely stop MS. According to Cleveland Clinic, switching treatments may be considered when:
If you believe you’re having a relapse, communicate with your healthcare provider. Be sure to tell them how your relapse feels. It can sometimes be difficult to know whether you’re experiencing a clinical MS relapse or MS symptoms made worse by stress or infection.
DMTs have different mechanisms of action, which means they work in different ways. Most DMTs modify different aspects of the immune system to prevent autoimmune attacks on the myelin that sheathes nerve fibers. Understanding how DMTs work can provide insight into why your doctor recommends a medication. For instance, if you’re switching drugs because the DMT you’ve been taking hasn’t helped, your doctor will likely recommend a drug that works in a different way.
Here’s a breakdown of DMTs for relapsing MS by mechanism of action.
| How Different DMTs Work in Relapsing-Remitting Multiple Sclerosis | ||
| Disease-modifying treatments | Believed mechanism of action | |
| Alemtuzumab (Lemtrada) | Alemtuzumab lowers the number of circulating B cells and T cells. | |
Cladribine (Mavenclad)a | Cladribine reduces the number of white blood cells, especially B cells. | |
Fingolimod (Gilenya)b | These drugs block white blood cells from leaving lymph nodes, reducing their numbers in the central nervous system. | |
Glatiramer acetate (Copaxone) | Glatiramer acetate encourages and activates helper T cells and regulatory T cells. It supports the growth and development of neurons (brain cells). It may also target antigen-presenting cells involved in autoimmune attacks. | |
Interferon beta-1a (Avonex) | Beta-interferons inhibit T-cell numbers and activation. They encourage the activity of regulatory T cells and the death of T cells involved in autoimmunity. They help prevent the migration of white blood cells across the blood-brain barrier. | |
Interferon beta-1b (Betaseron) | These work similarly to interferon beta-1a, above. | |
Monomethyl fumarate (Bafiertam)c | These reduce inflammation involved in MS. | |
| Natalizumab (Tysabri) | Natalizumab prevents white blood cells from migrating into inflamed tissues. | |
Ocrelizumab (Ocrevus) | These drugs encourage the destruction of B cells involved in MS attacks. | |
Teriflunomide (Aubagio) | Teriflunomide reduces the number of activated white blood cells in the central nervous system. | |
| Ublituximab (Briumvi) | A monoclonal antibody designed to bind B cells — a type of white blood cell — and decrease their numbers. | |
| Based on information sourced from “CMSC Practical Guidelines for the Selection of Disease-Modifying Therapies in Multiple Sclerosis” at https://cmscscholar.org/cmsc-practical-guidelines-for-the-selection-of-disease-modifying-therapies-in-ms/ aBased on information sourced from “The Story of Cladribine Reaches Its Climax” provided by Nature at www.nature.com/articles/d42859-018-00029-1 bBased on information sourced from “Vumerity Oral Capsules Approved by the FDA for Adults with Relapsing Forms of MS, Including Active SPMS ” provided by the Multiple Sclerosis Association of America at https://mymsaa.org/news/vumerity-approved-fda-adults-relapsing-ms-including-spms/ cBased on information sourced from Bafiertam at www.bafiertam.com dBased on information sourced from “FDA Approves Ocrevus Zunovo (ocrelizumab & hyaluronidase-ocsq), Similar to Ocrevus” provided by National Multiple Sclerosis Society at https://www.nationalmssociety.org/news-and-magazine/news/fda-approves-ocrevus-zunovo | ||
For people living with active relapsing MS, your healthcare team may use MRI scans and biomarker tests to help you make the choice about which DMT to try. Sometimes, the only way to know whether a DMT will be effective for you is to begin taking it. Many people with relapsing MS find it necessary to switch to a different DMT over the course of their treatment. If you’re curious about what treatment options for relapsing MS are available for you, talk to your neurologist.
On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 218,000 members come together to ask questions, give advice, and share their stories with those who understand life with MS.
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