MS Medications
Several different types of medication may be prescribed to people who have multiple sclerosis (MS).
Disease-modifying therapies (DMTs) can prevent acute MS attacks, or relapses, and slow the progression of the disease, thereby preventing physical and cognitive disability. Other drugs, primarily corticosteroids, are used to help control severe symptoms during relapses.
There are also numerous drug treatments for managing ongoing symptoms associated with multiple sclerosis, such as pain, tremors, walking difficulty, and muscle spasticity.
Disease-Modifying Therapies for MS
Disease-modifying therapies (DMTs) are sometimes called “immunomodulators,” because they affect the functioning of the immune system. They do not make you feel better in the short term, nor do they address specific MS symptoms. But they are effective at slowing the progression of disability caused by multiple sclerosis and lowering the frequency and severity of acute attacks in people who have the most common type of the disease, known as relapsing-remitting MS (RRMS). They also reduce the development of new lesions (areas of damage, or scarring, in the brain and sometimes spinal cord), as seen on MRI (magnetic resonance imaging) scans.
In addition to being used to treat RRMS, DMTs may also be prescribed to people with “active” secondary-progressive MS (SPMS). Secondary-progressive MS is a second phase of RRMS during which there is symptom progression, accompanied by increased disability. People are said to have “active” SPMS if they still experience relapses and new lesions are seen on their MRIs.
DMTs may additionally be offered to some people with clinically isolated syndrome (CIS), which is a first episode of neurological symptoms caused by inflammation or damage to the myelin in the central nervous system. However, the prescribing doctor would need to first evaluate whether that person is at high or low risk of developing MS.
Some DMTs are more effective than others at slowing disability progression, but the more effective drugs also tend to have more, or more serious, side effects. That’s why people diagnosed with MS and their doctors need to work together to find the right benefit-to-risk balance when selecting a DMT.
For people with primary-progressive MS (PPMS), in which the disease progresses and disability worsens without either noticeable relapses or periods of improvement, only one disease-modifying medication, Ocrevus (ocrelizumab), has been shown to lower the risk of disability progression.
RELATED: Early, Aggressive MS Treatment Superior to Escalation Approach, Study Shows
Individuals wishing to have children should additionally discuss with their doctors which DMTs are — and are not — safe to take while trying to conceive, during pregnancy, and when breastfeeding. For some drugs, there are clear-cut guidelines, as described in an article published in February 2023 in Neurology and Therapy, while for others, the risks and benefits of continuing the drugs versus stopping them must be weighed on an individual basis.
The same precautions apply to taking drugs used to treat MS symptoms: Some are known to be unsafe during pregnancy and breastfeeding, some carry risks but might be continued under some circumstances, and some have not been studied adequately.
Drugs Approved for Relapsing MS
Relapsing MS generally encompasses clinically isolated syndrome, relapsing-remitting MS, and active secondary-progressive MS. The U.S. Food and Drug Administration (FDA) has approved the following drugs to treat relapsing forms of MS:
Injections
Avonex and Rebif (interferon beta-1a) and Betaseron and Extavia (interferon beta-1b) are injected into the muscle (intramuscular) or under the skin (subcutaneous). It's believed that these drugs work by controlling inflammation in the central nervous system (CNS).
Copaxone (glatiramer acetate) is a subcutaneous injection that attracts immune-system cells (T cells) that would otherwise attack myelin sheaths.
Glatopa (glatiramer acetate) is considered a generic equivalent of Copaxone.
Kesimpta (ofatumumab) is a self-administered subcutaneous injection that’s taken once a month using a prefilled auto-injector pen. Like Ocrevus, Kesimpta depletes CD20-positive B lymphocytes, a type of white blood cell believed to be involved in the autoimmune process that leads to the development and progression of MS.
Plegridy (peginterferon beta-1a) is a longer-lasting form of interferon.
Oral Medications
Aubagio (teriflunomide) is a once-daily capsule that blocks the production of immune-system cells. Teriflunomide is known from animal studies to cause birth defects. It should be stopped prior to trying to conceive, and it should not be used during pregnancy or breastfeeding.
Bafiertam (monomethyl fumarate) works similarly to Tecfidera and Vumerity and, like them, is taken as a twice-daily capsule.
Gilenya (fingolimod) is a once-daily pill that prevents T cells from getting out of lymph nodes and into the bloodstream. In December 2019, the FDA approved three applications for generic versions of Gilenya. Fingolimod should not be used during pregnancy. It is a known teratogen, meaning it can cause birth defects. In fact, it should be stopped at least two months prior to trying to conceive, and it should not be used during breastfeeding.
Mavenclad (cladribine) is a pill that’s taken in two 10-day courses, one year apart. It works by killing T and B cells, preventing them from damaging the nerves in the brain and spinal cord. Mavenclad is intended for use in people who have already tried and not responded to or tolerated another MS medication. It is not recommended for the treatment of clinically isolated syndrome. Cladribine is known to cause birth defects, and both men and women using the drug should avoid conception for six months following a 10-day course of the drug. Women should refrain from breastfeeding for at least seven days following the last dose.
Mayzent (siponimod) is a pill taken once daily that works similarly to Gilenya. It belongs to the same class of drugs as fingolimod (Gilenya), and while there are no data available regarding the use of siponimod during pregnancy, it is assumed it may have the same effects as fingolimod.
Ponvory (ponesimod) is an oral tablet taken once daily that works similarly to Gilenya, Mayzent, and Zeposia. It belongs to the same class of drugs as fingolimod (Gilenya), and while there are no data available regarding the use of ponesimod during pregnancy, it is assumed it may have the same effects as fingolimod.
Tascenso ODT (fingolimod) is an orally disintegrating tablet that’s taken once daily. The drug is a bioequivalent to Gilenya.
Tecfidera (dimethyl fumarate) is a twice-daily oral capsule that lowers central nervous system inflammation and the ability of immune cells to get into the CNS. A generic version of Tecfidera is available in the United States.
Vumerity (diroximel fumarate) is an oral capsule that’s taken twice daily and that works similarly to Tecfidera, but is believed to cause fewer gastrointestinal side effects than Tecfidera.
Zeposia (ozanimod) is an oral capsule, taken once daily. Zeposia is one of a class of drugs known as S1P receptor modulators, which sequester cells within lymph nodes, thereby preventing them from entering the central nervous system and causing inflammation. Ozanimod belongs to the same class of drugs as fingolimod (Gilenya), and while there are no data available regarding the use of ozanimod during pregnancy, it is assumed it may have the same effects as fingolimod.
Infusions
Briumvi (ublituximab) is a monoclonal antibody designed to target B cells — a type of white blood cell — and reduce their numbers. It’s given as a one-hour IV infusion every six months, following the first dose.
Novantrone (mitoxantrone) is an immunosuppressant drug administered by IV infusion. It requires regular cardiac monitoring, and there is a total maximum amount an individual can receive over their lifetime. Novantrone is not approved to treat clinically isolated syndrome.
Ocrevus (ocrelizumab) is an IV infusion that works by targeting CD20-positive B lymphocytes and destroying them. It's the only drug approved by the FDA for to treat PPMS in addition to relapsing forms of MS. In September 2024 the FDA?approved a subcutaneous version of ocrelizumab called Ocrevus Zunovo. The twice-a-year, under-the-skin dosing regimen gives people living with MS another treatment delivery option.
Tysabri (natalizumab) is an IV infusion that works by binding to white blood cells and interfering with their movement from the bloodstream into the CNS.
Second-Line Therapy for Relapsing MS
The FDA has also approved the IV drug Lemtrada (alemtuzumab) for adults who have either relapsing-remitting MS or active secondary progressive MS and who haven't responded well to two or more types of disease-modifying medication.
Alemtuzumab works by rapidly depleting the body's supply of immune (T and B) cells, which temporarily stops the immune-system effects on your CNS and allows your body to create new cells, which might not attack myelin sheaths.
The FDA recommends using it only as a second-line therapy (after other drugs have failed) because it increases the risk of complications, including severe infections, development of new autoimmune diseases, and other potentially dangerous conditions.
Women taking alemtuzumab should wait four months following treatment to try to conceive. The drug should not be administered during pregnancy, and women are cautioned against breastfeeding during treatment with alemtuzumab.
Off-Label RRMS Treatment
The monoclonal antibody Rituxan (rituximab), which is considered a high-efficacy MS treatment, is not approved to treat MS in the United States but is sometimes prescribed off-label to treat relapsing-remitting MS. It is administered intravenously in a healthcare setting.
Rituxan works similarly to Ocrevus, targeting CD20-positive B lymphocytes and destroying them.
MS Medication Side Effects
All drugs can have adverse side effects; those associated with MS medication can range from mild to serious.
Mild side effects include irritation at an injection site (for drugs that are injected or infused) and flu-like symptoms following injections of the interferon beta drugs Betaseron, Extavia, Avonex, Rebif, and Plegridy.
Interferon beta medication can also cause depression as a side effect.
Many MS drugs raise the risk of infection — and infection, in turn, can worsen MS symptoms. While not all infections can be prevented, it’s important to be aware of this risk and keep an eye open for signs and symptoms of infection.
Of particular concern during the COVID-19 pandemic is that taking certain DMTs may reduce an individual’s response to the available COVID-19 vaccines. According to the?National Multiple Sclerosis Society, people with MS who use the following DMTs may benefit from a third dose of an mRNA vaccine to raise the likelihood of their mounting an immune response against COVID-19:
- Gilenya, Mayzent, Zeposia, or Ponvory
- Lemtrada
- Ocrevus, Kesimpta, Rituxan, and biosimilars
The most serious potential side effect of certain MS drugs is progressive multifocal leukoencephalopathy (PML), a viral infection of the brain associated with the JC (John Cunningham) virus. Among MS drugs, Tysabri is associated with the highest risk of PML, and its drug label contains a warning about this risk.
Treatments for Relapses
For MS relapses, especially severe ones that interfere with a person's mobility, safety, or ability to function, doctors may prescribe short-term, high-dose corticosteroids.
These drugs help shorten recovery time by reducing inflammation in the body.
Examples of corticosteroids include:
- Decadron (dexamethasone)
- Deltasone (prednisone)
- Solu-Medrol (methylprednisolone)
Steroids are typically given intravenously for three to five days, and may be followed by a tapered dose of an oral steroid over one to two weeks.
RELATED: 6 Side Effects of MS Steroid Treatment
People who cannot tolerate the side effects of high-dose steroids may be prescribed H.P. Acthar Gel (corticotropin), which stimulates the adrenal cortex to secrete various steroid hormones.
For people whose symptoms haven't responded to steroids, a treatment called plasmapheresis (plasma exchange) is available.
Plasma is the liquid part of your blood, and it contains autoantibodies, a type of protein that the immune system produces to attack the body's cells and tissues.
Plasmapheresis involves separating plasma from your blood cells and then returning the blood cells to your body along with fresh plasma or a plasma substitute.
Another possible option for treatment of MS relapses that don’t respond to steroids or that occur during pregnancy is intravenous immunoglobulin replacement therapy (IVIG). In IVIG, a product made from donated blood and containing a concentrated assortment of antibodies — proteins your body normally makes to fight infections — is administered via IV over several hours.
Drugs for MS Symptom Management
Given the wide range of symptoms caused by MS, doctors often also prescribe a variety of drugs to ease individual symptoms.
These can include:
- Ampyra (dalfampridine), an oral medication used to improve walking in adults with MS
- Analgesics (pain medication)
- Antibiotics to treat urinary tract infections (UTIs), respiratory infections, and other infections
- Anticonvulsants to treat neuropathic pain or tremors
- Antidepressants
- Antispasmodics, such as baclofen, and muscle relaxants, such as Zanaflex (tizanidine), to ease muscle spasticity
- Medication to treat gastrointestinal problems, such as nausea, ulcers, and constipation
- Nuedexta (dextromethorphan and quinidine) to treat pseudobulbar affect
- Viagra (sildenafil) and similar drugs for erectile dysfunction
Resources
These resources can help you learn more about the drugs used to treat MS as well as research on possible new MS therapies.
The Accelerated Cure Project enables you to get involved in research to help further progress toward new drugs and other therapies for MS.
MS Selfie
The website of Gavin Giovannoni,?MBBCh, PhD, a professor of neurology at the Blizard Institute at Barts and The London School of Medicine and Dentistry, covers all aspects of MS, including drug treatment.
MedPage Today
If you want to know what your MS care team is reading about MS news and research, here’s the place to looks.
Multiple Sclerosis Association of America (MSAA)
The MSAA has compiled information on prescription assistance programs for MS disease-modifying therapies. Each program works somewhat differently, so you’ll need to read the details to know whether you qualify for assistance.
My MS Manager App
My MS Manager allows you to track your MS symptoms, medication use, and medication side effects, so you can have a record of your disease and treatment for yourself and to discuss with your doctor.
National Multiple Sclerosis Society (NMSS)
The NMSS maintains a wide-ranging collection of resources on MS medications, including DMTs, treatments for relapses, symptomatic treatments, and medicines sometimes used off-label to treat MS.
Patient-Centered Outcomes Research Institute (PCORI)
Learn about the MS-specific research being done by PCORI, including drug comparison studies that could lead to better decision-making when choosing DMTs and other medications used in MS treatment.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
- FDA Approves First Generics of Gilenya. U.S. Food and Drug Administration. December 5, 2019.
- FDA Approves New Drug to Treat Multiple Sclerosis.?U.S. Food and Drug Administration. March 29, 2017.
- Lemtrada Prescribing Information. U.S. Food and Drug Administration.
- COVID-19 Vaccines and Additional Doses. National Multiple Sclerosis Society. May 5, 2023.
- FDA Drug Safety Communication: New Risk Factor for Progressive Multifocal Leukoencephalopathy (PML) Associated With Tysabri (natalizumab). U.S. Food and Drug Administration. January 20, 2012.
- Iyer P and Dobson R. Multiple Sclerosis in Pregnancy: A Commentary on Disease Modification and Symptomatic Drug Therapies. Neurology and Therapy. February 2023.
Jason Paul Chua, MD, PhD
Medical Reviewer
Joseph Bennington-Castro
Author
Joseph Bennington-Castro is a science writer based in Hawaii. He has written well over a thousand articles for the general public on a wide range topics, including health, astronomy, archaeology, renewable energy, biomaterials, conservation, history, animal behavior, artificial intelligence, and many others.
In addition to writing for Everyday Health, Bennington-Castro has also written for publications such as Scientific American, National Geographic online, USA Today, Materials Research Society, Wired UK, Men's Journal, Live Science, Space.com, NBC News Mach, NOAA Fisheries, io9.com, and Discover.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
- FDA Approves First Generics of Gilenya. U.S. Food and Drug Administration. December 5, 2019.
- FDA Approves New Drug to Treat Multiple Sclerosis. U.S. Food and Drug Administration. March 29, 2017.
- Sanofi: Genzyme’s Lemtrada Approved by the FDA. Sanofi. November 15, 2014.