Multiple Sclerosis: Management, Medications, & Treatment Options

Medically reviewed by
Evelyn O. Berman, MD
, Assistant Professor of Neurology and Pediatrics at University of Rochester, Rochester, NY  | Written by 
Emily Wagner

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After you receive a multiple sclerosis (MS) diagnosis, your doctor will discuss your treatment options with you.

Unfortunately, there is no cure for MS.1 However, the disease can be managed with different therapies that target the immune system to help prevent further nerve damage. You may also receive medications that help manage relapses and treat your MS symptoms. Rehabilitation programs for physical and occupational therapy can help you manage everyday activities.

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What is Multiple Sclerosis?Clinical Trials for Multiple Sclerosis

How Is MS Treated?

MS treatments focus on three areas: reducing damage to the nervous system, managing relapses, and treating symptoms.

Disease-Modifying Therapies for MS

Disease-modifying therapies (DMTs) are MS medications that help prevent the formation of new lesions on the brain and spinal cord, relapses, and worsening of disability.2 The U.S. Food and Drug Administration (FDA) has approved several DMTs for treating MS. Once you receive an MS diagnosis, your doctor will likely have you start a DMT.

For them to be the most effective, DMTs need to be taken on a regular schedule. DMTs are taken long-term as maintenance treatment to help prevent disease progression.

Most DMTs are taken at home by pill or injection. Some require a visit to your doctor’s office or infusion center. Each medication has a different dosing schedule — for example, most oral DMTs are taken daily, while injected DMTs are taken weekly.3

Oral DMTS

Oral DMTs approved by the FDA include:3

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

Injectable DMTs

Injectable DMTs approved by the FDA include:3

  • Glatiramer acetate (Copaxone®, Glatopa®)
  • Interferon beta-1a (Avonex®)
  • Interferon beta-1a (Rebif®)
  • Interferon beta-1b (Betaseron®)
  • Interferon beta-1b (Extavia®)
  • Ofatumumab (Kesimpta®)
  • Peginterferon beta-1a (Plegridy®)
  • Ublituximab (pending approval)

Infused DMTs

Infused DMTs approved by the FDA include:3

  • Alemtuzumab (Lemtrada®)
  • Mitoxantrone (Novantrone®)
  • Natalizumab (Tysabri®)
  • Ocrelizumab (Ocrevus®)
  • Ublituximab

Side Effects of DMTs

DMTs work by limiting the activity of the immune system, which stops it from attacking the fatty coating on nerve cells (myelin) in MS. However, this also means that the immune system can’t fight infections as well as before, leaving you more susceptible to infections.

Other side effects caused by DMTs include:2

  • Headache
  • Flu-like symptoms
  • Upset stomach/nausea
  • Pain, swelling, or redness at the injection site (for injected or infused DMTs)

One complication that can occur from using DMTs is progressive multifocal leukoencephalopathy (PML). This is a rare condition caused by reactivation of the John Cunningham (JC) virus, which affects the white matter in the brain. It targets the cells responsible for making myelin, leading to severe nerve damage and, in some cases, death. Some DMTs, such as Tysabri®, may prevent the immune system from fighting off the JC virus, allowing it to reinfect you. Because of this, your doctor will test you for the virus before beginning DMT treatment.3

Medications for MS Relapses

MS is a disease characterized by periods of relapse, or the development of new or worsening symptoms. During a relapse, inflammation levels in the central nervous system (CNS) increase and myelin becomes damaged, leading to symptoms. To be considered a relapse, symptoms must last for at least 24 hours and occur at least 30 days after the last attack. These can last between a few days to a few months.

Corticosteroids

To help dampen inflammation immediately and help shorten the length of a relapse, your doctor may prescribe corticosteroids, such as oral prednisone (Deltasone®) and intravenously (IV)-infused methylprednisolone (Solu-Medrol®). Adrenocorticotropic hormone (ACTH) gel (H.P. Acthar® Gel) contains purified ACTH hormone that’s used to treat relapses in those who don’t respond well to corticosteroids.4

Short-term use of corticosteroids can help control relapses, but they’re not recommended for long-term use. Side effects that can develop with extended use of these therapies include weight gain, high blood sugar, bone thinning (osteoporosis), and increased risk of infections.5

Plasmapheresis

Plasmapheresis, also known as therapeutic plasma exchange, involves removing your blood through one needle and filtering it to remove harmful antibodies causing MS symptoms. The blood is then mixed with saline or donor plasma and returned to your body through another needle.

The American Academy of Neurology (AAN) recommends plasmapheresis for those with severe MS relapses that aren’t well-managed with corticosteroids. The treatment isn’t recommended for people with progressive forms of MS.6,7

Side effects of plasmapheresis include:8

  • Low blood pressure
  • Bleeding
  • Shortness of breath
  • Hypocalcemia, or low blood concentrations of calcium
  • Hypokalemia, or low blood concentrations of potassium
  • Metabolic alkalosis, or blood chemistry imbalance, which can cause headaches or seizures
  • Allergic reactions to plasma given by a donor

Treating MS Symptoms

Nerve damage caused by MS eventually leads to a wide variety of symptoms that affect the entire body. Fortunately, many of these can be managed with other medications to help you get back to your daily activities. Symptoms of MS and their treatments include:3

  • Pain — Duloxetine (Cymbalta®), gabapentin (Neurontin®), pregabalin (Lyrica®), venlafaxine (Effexor®)
  • Tremors — Clonazepam (Klonopin®), isoniazid (Laniazid, Nydrazid®)
  • Bladder problems — Mirabegron (Myrbetriq®), onabotulinumtoxin A (Botox®), oxybutynin (Ditropan®)
  • Bowel problems — Bisacodyl (Dulcolax®), docusate (Colace®), magnesium hydroxide (milk of magnesia)
  • Muscle spasticity — Baclofen, clonazepam, diazepam (Valium®), dantrolene (Dantrium®)
  • Difficulties walking — Dalfampridine (Ampyra®)
  • Fatigue — Dextroamphetamine and amphetamine (Adderall®), fluoxetine (Prozac®), methylphenidate (Ritalin®)
  • Sexual problems — Alprostadil (Muse®), avanafil (Stendra®), sildenafil (Viagra®), tadalafil (Cialis®)

Rehabilitation While Living With MS

Over time, nerve damage caused by MS can lead to the decline in muscle function. You may find it more difficult to perform daily tasks such as housework, driving, or simply walking. Rehabilitation services can help you regain strength or learn new ways to adapt your home and workplace to your needs.

Physical therapists (PTs) can help address balance and mobility issues while living with MS. They may develop an exercise program for you to strengthen your muscles, or they may teach you how to use assistive devices (walker, cane, etc.) so that you can maintain your mobility.

Occupational therapists (OTs) specialize in teaching you how to use new tools and devices to make everyday tasks easier. They can also make suggestions for ways to make your home and workplace safer and more accessible if you have mobility issues.9

The Future of MS Treatments

As doctors and researchers continue to learn more about MS, new treatments will eventually be discovered. Currently, there are numerous clinical trials investigating these new therapies, in addition to repurposing already existing treatments used for other autoimmune diseases.

Learn more about new MS treatment options currently being developed and ongoing MS clinical trials.