MS progression treatment:
- Ocrelizumab (Ocrevus) is the only FDA-approved disease-modifying therapy (DMT). It is prescribed to patients with primary-progressive MS, and those receiving the progressive MS treatment are slightly less likely to progress than untreated.
As most of the immune response associated with MS occurs in the early stages of the disease, aggressive treatment as early as possible can lower the relapse rate, slow the formation of new lesions, and potentially reduce the risk of brain atrophy and disability accumulation.
Several MS therapies carry significant health risks. Selecting the right therapy for the patient is based on many factors including duration and severity of disease, the effectiveness of previous MS treatments, other health issues, cost, and child-bearing status.
Treatment options for MS include injectable and MS oral medications.
Progression multiple sclerosis injections include:
- Interferon-beta medications are among the most commonly prescribed progressive MS medications. They can decrease the frequency and severity of relapses. There are some side effects such as injection-site reactions and flu-like symptoms. Liver damage is also among the side effects, so it is usually advised to monitor liver enzymes. Also, patients may develop neutralizing antibodies that can reduce the drug’s effectiveness.
- Glatiramer acetate (Copaxone, Glatopa) may help block the immune system’s attack on myelin. Skin irritation at the site of progressive multiple sclerosis injections is the side effect of the progressive MS treatment.
MS oral treatments include:
- Fingolimod (Gilenya) is one of progression MS oral medications that reduces the relapse rate. It is taken once daily. It is advised to monitor heart rate and blood pressure for six hours after the first dose, as the heartbeat may be slowed. Other possible side effects include rare serious infections, blurred vision, headaches, and high blood pressure.
- Dimethyl fumarate (Tecfidera) is taken twice daily. It is advised to have blood test monitoring on a regular basis. Side effects may include diarrhea, nausea, flushing, and lowered white blood cell count.
- Diroximel fumarate (Vumerity) is similar to dimethyl fumarate and is also approved for relapsing MS treatment. Typically, it causes fewer side effects.
- Teriflunomide (Aubagio) is taken once daily and requires blood test monitoring on a regular basis. Among side effects are liver damage, hair loss, and others. Birth defects are associated with the drug when taken by both men and women, so such patients should use contraception during treatments and for up to two years later. On a consultation before pregnancy, a doctor can recommend ways to speed the elimination of the drug from the body.
- Siponimod (Mayzent) is approved for relapse and secondary-progressive MS. Among side effects are viral infections, liver problems, and low white blood cell count. Other possible side effects include changes in heart rate, headaches, and troubling vision. Siponimod is harmful to a developing fetus, so women should use contraception when taking this progression MS medication and for 10 days after the treatment. It is advised to get heart rate and blood pressure monitored for six hours after the first dose. This drug requires blood test monitoring on a regular basis.
- Cladribine (Mavenclad) is usually prescribed as second-line treatment for patients with relapsing-remitting MS or secondary-progressive MS. The treatment consists of two courses, spread over a two-week period, for two years. There are several side effects like upper respiratory infections, headaches, tumors, serious infections, and lower levels of white blood cells. People with active chronic infections or cancer, pregnant or breastfeeding women should not take this drug. Men and women should use contraception when taking this medication and for the following six months. Patients may need blood tests monitoring during progression MS treatment.
Progression MS infusion treatments include:
- Ocrelizumab (Ocrevus) is the only DMT approved by the FDA to treat both the relapse-remitting and primary-progressive forms of MS. It is given in a form of an intravenous infusion. There are several possible side effects including irritation at the injection site, low blood pressure, fever, and nausea. Some patients, including those with hepatitis B infection, should choose another treatment. Ocrelizumab may also increase the risk of some types of cancer, particularly breast cancer, and infections.
- Natalizumab (Tysabri) is a first-line treatment for severe MS or second-line treatment in other MS. The drug reduces the movement of potentially damaging immune cells in the bloodstream to the brain and spinal cord. This medication increases the risk of progressive multifocal leukoencephalopathy (PML) in people who have antibodies to the causative agent of PML, the JC virus. Patients without the antibodies have a low risk of PML.
- Alemtuzumab (Campath, Lemtrada) targets a protein on the surface of immune cells and depletes white blood cells, which decreases potential nerve damage. But it also increases the risk of infections and autoimmune disorders, including a high risk of thyroid autoimmune diseases and rare immune-mediated kidney disease. Treatment with alemtuzumab consists of five consecutive days of drug infusions, followed by another three days of progression MS infusion treatments a year later. The drug is only available from registered providers, and people treated with the drug must be registered in a special drug safety monitoring program.
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