Prior to the 1990s, a diagnosis of MS (multiple sclerosis) could mean a life sentence of crippling disability. Medication treatment options for MS were very limited. Relapses were often treated with corticosteroid drugs, which can reduce the length of an attack, but nothing was available that could alter the course of the disease.

This grim outlook changed with the introduction of the Interferon beta drugs, which can actually reduce the number of attacks or relapses. If started early enough, the drugs may even prevent the disease in some high-risk people.

The Importance of Early Treatment

Traditionally, doctors did not diagnosis MS, let alone treat it, until a patient had experienced at least two attacks. However, the use of MRIs is showing that even when in remission, the disease is actively attacking the myelin sheath around the nerve and creating lesions. In addition, the theory that only the myelin sheath, and not the nerve itself, is being attacked is being challenged. A growing body of evidence indicates that a part of the nerve called axons are also damaged. Although the myelin sheath can repair itself, the nerve cannot; the damage is irreversible. For these reasons, in 1998 the National Multiple Sclerosis Society issued a recommendation for early treatment of MS. If you are newly diagnosed, your doctor should be discussing medication treatment options with you even if you have not had a second attack.

Goals of Treatment for MS

The goals of treatment for people with relapsing-remitting MS have broadened in the past few years. Although MS cannot be cured or reversed, the progress of the disease can be affected. Currently, the goals of treatment for MS are threefold:

Improve recovery from attacks
Prevent or reduce the number of attacks
Slow the progression of the disease
To speed recovery from an attack, corticosteroid drugs are used to reduce the inflammation in nerve tissue. They also decrease antibody production. The corticosteroids do have side effects, and prolonged use has been associated with osteoporosis, possible mood changes and hypertension. Two steroids commonly used are Prednisone and Solu-Medrol.

The ABC Drugs

Another class of drugs, Interferon beta, reduces the number of attacks in people with relapsing-remitting MS. At this time, the FDA has only approved the use of interferon betas in people with relapsing-remitting MS who are able to walk. There are two types of Interferon beta: Interferon beta-1a and Interferon beta-1b.

Interferon beta-1a, also known as Avonex (Rebif in Canada), not only decreases the frequency of attacks, but has been found to slow the progress of MS. Avonex is administered by an intramuscular (into muscle tissue) injection once a week. In some people, it causes flu-like symptoms, and a small number of people have skin reactions. Depression is another side effect that has been noted.

Interferon beta-1b, also known as Betaseron, reduces the frequency of attacks, but has not been shown to slow the disease itself. Betaseron is administered by a subcutaneous (right under the skin) injection every other day. Among the side effects associated with its use are flu-like symptoms and skin reactions and inflammations at the injection site, and depression. Both forms of interferon are expensive, costing $8,000 to $10,000 (US$) per year.

An alternative to the Interferon beta drugs is glatiramer acetate, also known as Copaxone, which reduces the frequency of attacks. This drug can be used by people who can’t tolerate the Interferon beta class of drugs. Copaxone is administered daily by a subcutaneous injection. Among the possible side effects are flushing, shortness of breath and some swelling at the injection site.

Treatment of Progressive and Advanced MS

Individuals who are in the progressive stage of MS are often treated with methotrexate, cyclophosphamide or cyclosporine. Treatment at this stage often has only limited success, due to the extensive damage that is usually present in the brain and spinal cord. The cancer drug mitoxantrone (Novantrone) was approved by the FDA in October 2000 to treat advanced MS.

The drugs discussed in this article are those that have been approved by the FDA for use with MS patients. Many therapies to treat MS are being researched worldwide, including immunosuppressive agents, plasma exchange and the transplant of cells that make myelin. Although many of these treatments may prove to be unsuccessful, the progress that has been made shows that the course of MS can be changed.

I want to add, as a personal note, that I had an MRI almost four years after the one that was done when I had my first attack. I have been on Avonex the whole time except for when I was trying to conceive and was pregnant. The recent MRI showed that there had been no further damage since my first attack, which is really incredible.

Related Links

Early Treatment Can Limit MS
A discussion of how the Interferon beta drugs can slow MS.