Treatment of Multiple Sclerosis
The treatment of MS, which has been revolutionized over the past 15 years, involves corticosteroids for acute exacerbations, disease-modifying drugs that alter the course of the disease, and therapies that alleviate some of the daily symptoms associated with the disease
Treatment of Exacerbations
When given intravenously (i.e. through a vein in the arm), a short course of high dose corticosteroids (which are not the same as anabolic steroids used by some athletes) shorten the duration of an MS exacerbation and help symptoms resolve more rapidly. However, they do not seem to affect the degree of recovery. Because steroids do not seem to affect long-term outcome and they can cause side effects, not every MS exacerbation (e.g. a relapse consisting of mild numbness or tingling) requires treatment.
Patients experiencing MS relapses often have the option of receiving intravenous steroids as an outpatient at the Columbia University MS Center. Unfortunately, with or without steroids, symptoms from a relapse do not completely resolve about 35 percent of the time. Therefore, it is imperative to try to prevent relapses. This is one reason why it is important for most MS patients to be treated with one of the disease-modifying drugs (see below).
The Disease-Modifying Drugs
Currently, there are eight medications (the four beta interferons (Avonex®, Betaseron®, Extavia®, and Rebif®), glatiramer acetate (Copaxone®), natalizumab (Tysabri®), fingolimod (Gilenya®) and mitoxantrone (Novantrone®)), approved by the United States Food and Drug Administration (FDA) that alter the course of MS. These medications are administered by either injection under the skin or into a muscle, infusion into a vein, or taken orally as a daily tablet. These therapies reduce relapses, lessen the accumulation of disability, and decrease the number of new MRI abnormalities. The disease-modifying drugs are preventive; they do not improve symptoms or make patients feel better (see Symptomatic Therapies below).
MS treatment must be individualized. No one therapy is right for everyone. At the Columbia University MS Center, the indications and side effects of the disease-modifying therapies and treatment options will be discussed with you in detail.
Avonex®, Betaseron®, Copaxone® and Rebif® are modestly effective in treating relapsing-remitting MS. These medications, which are injected as infrequently as once a week and as often as every day, have different side effect profiles, but all are safe and generally well-tolerated.
Tysabri®, which is infused into a vein every 4 weeks, is FDA-approved for relapsing forms of MS. It seems to be more effective than the injectable therapies, but is associated with progressive multifocal leukoencephalopathy (PML), a rare and often fatal viral illness of the brain. As a result, Tysabri® is currently used mainly for patients who do not respond to the injectable medications.
Gilenya®, (fingolimod) is a sphingosine 1-phosphate receptor modulator, which we believe acts by sequestering certain white blood cells (lymphocytes) in the lymph nodes, thereby preventing those cells from entering the central nervous system. Gilenya is the first oral disease modifying agent for relapsing forms of multiple sclerosis and it was approved by the FDA in October 2010. It requires initial cardiac monitoring and ongoing monitoring of blood count and liver function, as well as regular ophthalmologic evaluations.
Novantrone®,which is administered through a vein every 3 months, is effective in treating secondary progressive and rapidly worsening MS. Novantrone® also has the potential to cause serious side effects, which should be discussed in detail before treatment is initiated.
Several medications are being studied in primary progressive MS, but there is currently no proven therapy for this form of the illness. Patients with primary progressive MS may be eligible to participate in a study of a new investigational drug at the Columbia University MS Center.
Many MS patients experience symptoms on a daily basis. Common symptoms include fatigue, depression, bowel and bladder problems, pain, numbness, tingling, stiffness, spasms, cognitive problems, weakness, and sexual problems. Some of these symptoms can be disabling (e.g. severe fatigue), socially distressing (e.g. bowel or bladder problems), or interfere with personal relationships (e.g. sexual problems).
Therapies to alleviate the daily symptoms of MS are an integral part of patient care at the MS Center. Treatment at the center is always individualized and we are well aware that not everyone responds similarly to medications. Our team of various health care professionals (e.g. neurologists, a nurse practitioner, urologists, physiatrists, physical therapists, occupational therapists) understands that optimal management of many of these symptoms usually requires a combination of medication with other interventions, such as rehabilitation, exercise, and/or lifestyle and environmental modifications. Proper identification and treatment of symptoms by the MS Center Team often maximizes function, improves quality of life, and increases independence.