Multiple sclerosis can take different disease courses, and each represents a different type of MS. Only certain types of MS have a risk for relapses — also known as flares, exacerbations, or attacks. Relapses are periods of new or worsening MS symptoms. Doctors sometimes disagree about the exact nature of MS, but relapsing forms of MS are often treated using the same medication options.
There are three types of relapsing MS: clinically isolated syndrome, relapsing-remitting MS, and active secondary progressive MS.
Clinically isolated syndrome is often the first episode of symptoms that eventually lead to a diagnosis of MS. CIS is diagnosed after neurological symptoms present for at least 24 hours. These symptoms must be due to demyelination (damage to the myelin that sheathes nerves) or inflammation in the central nervous system.
CIS is a condition that can convert (or progress) to MS. The risk for conversion is often predicted based on the quantity and size of brain lesions, as seen on initial baseline magnetic resonance imaging (MRI) scans. CIS is usually diagnosed in people between the ages of 20 and 40. Effective treatment soon after a diagnosis of CIS is important to delay the conversion to MS.
Relapsing-remitting MS is the most common form of MS. However, no two people experience RRMS the same way. This is because lesions can occur in different locations within the central nervous system, affecting different functions.
RRMS is characterized by defined attacks of new or increasing neurological symptoms. There are several risk factors for RRMS. Women are approximately two to three times more likely than men to be diagnosed with RRMS. The age of onset for RRMS is similar to that of CIS — between ages 20 and 40. However, children can also be diagnosed with RRMS. Genetics pose another risk factor, as RRMS can run in families.
After a period of time living with RRMS, this form can progress to secondary progressive MS. In people with SPMS, neurological symptoms continue to get worse without clear periods of remission. SPMS is considered active if relapses continue to occur, and inactive if there have been no relapses for a period of time. According to the National Multiple Sclerosis Society, without the use of approved disease-modifying therapies, 50 percent of those diagnosed with RRMS will likely transition to SPMS within 10 years, and 90 percent tend to transition within 25 years.
Although CIS, RRMS, and SPMS are distinctive forms of relapsing MS, they are often grouped together and share similar treatment options.
Disease-modifying therapies are the primary defense against progression in relapsing forms of MS. There are approximately 20 medications currently approved for the treatment of relapsing forms of MS. Research suggests DMTs can:
Those diagnosed with any type of relapsing MS should discuss disease-modifying therapies with a doctor as soon as possible. Early treatment can make a positive difference in slowing the progression of MS.
Different classes of medications are used as disease-modifying therapies in cases of relapsing MS. Each class works in a different way, and your neurologist can help you decide on the best treatment option for you.
Classes of drugs used as DMTs for MS include:
First-line DMTs are the initial treatments most commonly prescribed when a person is recently diagnosed with MS. Any FDA-approved DMT can technically be prescribed as a first-line drug. Generally speaking, first-line DMTs include:
If first-line drugs fail to reduce your rate of flares or slow the progression of MS, your doctor may suggest switching to a second-line drug. A neurologist might also recommend switching to a second-line DMT if you don’t have access to the first-line drug anymore, or you cannot tolerate the side effects of the first-line drug.
Second-line DMTs may include:
Learn more about what to expect when starting an S1P receptor modulator.
MS is a debilitating disease that will progres — or continue to get worse — as time goes by. There is not yet a cure for MS. However, beginning a DMT treatment as early as possible following diagnosis can help delay the progression to more debilitating forms of MS.
There are many new MS drugs. At present, it is largely unknown how these medications might delay or lower the risk for MS progression in the long term. Long-term treatment with a DMT is the single most important factor in delaying MS progression.
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