Multiple sclerosis (MS) is an autoimmune disease. In people with MS, the body’s immune system attacks the myelin (fatty sheath) that insulates nerves in the brain and spinal cord, which make up the central nervous system (CNS). This process results in lesions (areas of damage) that cause MS symptoms.

There are now more treatment options for MS than ever before. They fall into three main categories: disease-modifying therapies (DMTs), medications used to treat relapses, and medications for managing MS symptoms.

Disease-Modifying Therapies

Disease-modifying therapies suppress aspects of the immune system to reduce autoimmune attacks and MS flare-ups (periods during which symptoms become active or worse). DMTs are considered maintenance treatments, meant to be taken long term to slow the progression of MS.

Most healthcare professionals agree that people should start DMTs as soon as possible after getting an MS diagnosis. Taking DMTs consistently without interruptions supports successful MS management.

The U.S. Food and Drug Administration (FDA) has approved several types of DMTs. Depending on the particular medication, DMTs may be given by infusions at the doctor’s office or taken at home as pills or with self-injections.

Injection at Home

The following medications can be injected subcutaneously (under the skin) at home:

• Glatiramer acetate (Copaxone)
• Interferon beta-1a (Avonex, Rebif)
• Interferon beta-1b (Betaseron, Extavia)
• Ofatumumab (Kesimpta)

The drug combo ocrelizumab and hyaluronidase-ocsq (Ocrevus Zunovo) is also available as a subcutaneous (under the skin) injection but, per the drug’s prescribing information, should be administered by a healthcare professional.

Intravenous Infusion

Other medications are infused intravenously (into a vein) at a clinic:

• Alemtuzumab (Lemtrada)
• Mitoxantrone
• Natalizumab (Tysabri)
• Natalizumab-sztn (Tyruko)
• Ocrelizumab (Ocrevus)
• Ublituximab (Briumvi)

Oral Medications

Medications taken orally (pills or capsules) include:

• Cladribine (Mavenclad)
• Dimethyl fumarate (Tecfidera)
• Diroximel fumarate (Vumerity)
• Fingolimod (Gilenya, Tascenso ODT)
• Monomethyl fumarate (Bafiertam)
• Ozanimod (Zeposia)
• Ponesimod (Ponvory)
• Siponimod (Mayzent)
• Teriflunomide (Aubagio)

Treatment for Different Types of MS

Most disease-modifying MS medications are approved only to treat relapsing forms of MS. These include clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), and cases of secondary progressive MS (SPMS) in which people continue to experience relapses.

Ocrelizumab is currently the only DMT approved to treat primary progressive multiple sclerosis (PPMS).

Read more about specific medications in this list of treatments for multiple sclerosis.

Side Effects of Disease-Modifying Therapy

Eligibility for some MS medications depends on whether you test positive for a common virus called the John Cunningham (JC) virus, which can cause serious side effects. Depending on which MS treatment you’re on, you may need to undergo regular blood tests for the JC virus while taking it and switch to a different treatment if your JC virus levels become too high.

Because DMTs suppress aspects of the immune system, many of these MS treatments can increase your risk for developing infections and, in rare cases, certain types of cancer. Each MS treatment has specific side effects and different risk levels. Your doctor can help you understand the risks and benefits of each MS medication based on your medical history and individual condition.

Shared Decision-Making

Shared decision-making is an effective approach to MS care in which treatment decisions are made as a collaboration between you and your doctor. Your doctor will provide information about the risks versus benefits of different treatment options, make recommendations, and answer your questions. You will communicate your preferences, priorities, and values to your doctor. Together, you will decide on the best treatment option.

Medication for Relapses

During an MS attack or flare-up, your doctor may prescribe temporary medications to treat symptoms and get the disease back under control. Standard treatment options for relapses include corticosteroids such as methylprednisolone (Solu-Medrol) and the closely related drug repository corticotropin hormone (Acthar Gel).

Corticosteroids (also called steroids) lower inflammation. When taken for short periods of time, corticosteroids are safe and effective for MS flare-ups. However, if taken long term, corticosteroids can cause side effects including:

• Osteoporosis (brittle bones)
• Cataracts (clouding of the eye lens)
• Serious metabolic disorders such as diabetes and Cushing’s syndrome

For those who can’t tolerate high doses of steroids or find them ineffective, there’s another option: plasmapheresis, also called “therapeutic plasma exchange.” This procedure involves removing, filtering, and replacing the blood plasma of the person undergoing treatment.

Symptom Management Medications

MS can cause a wide array of motor (movement-related), cognitive (brain-related), and general symptoms that have an impact on daily activities. When symptoms become severe, they can cause disability.

Some MS treatments can help manage some symptoms of the disease. Although these MS medications can improve function and quality of life, they do not treat the underlying disease or prevent its progress.

Various therapies can target different disease symptoms:

• Dalfampridine (Ampyra) can improve walking problems.
• Muscle relaxants such as tizanidine (Zanaflex), cyclobenzaprine (Amrix), and baclofen (Fleqsuvy, Gablofen, Lioresal, Lyvispah, Ozobax) can help with spasticity (muscle tightness or stiffness).

Other medications are available to address bowel, bladder, and sexual dysfunction, as well as vertigo, tremors, pain, and depression.

Some people with MS find relief from certain MS symptoms by using complementary or alternative treatments such as medical cannabis, vitamin D supplements, yoga, massage, or acupuncture.

Can Diet Help MS?

Like everyone else, people with MS feel their best when they consistently eat a healthy, balanced diet. There’s no official diet for people with MS. But you can meet with a registered dietitian nutritionist to learn more about fitting healthier foods into your lifestyle and finding what works best for you.

A balanced, nutritious diet can also help you maintain a healthy weight and lower your risk of developing dangerous chronic conditions such as diabetes, osteoporosis, and heart disease.

Find Your Team

MyMSTeam is the social network for people with MS and their loved ones. Here, more than 219,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

What treatments have you tried for MS? Have they been effective? Share in the comments below, or start a conversation by posting on your Activities page.