A few years ago there were no drugs to treat the underlying disease of MS. All of our treatments were directed at symptoms. However, in the last 7 years, 6 medications have been approved by the FDA for the treatment of MS. There are several decisions that MS patients need to make regarding these medications. The first is whether to treat and the second is which drug?

Should I take a disease modifying medication?

There are several things to consider in making this decision. The National MS Society does recommend that everyone with relapsing remitting MS consider being treated with one of these medications. This is because disease-modifying therapies do seem to work: they have been shown to reduce relapses, improve MRI appearance, and in some cases prevent progression of disability. However, the studies showing these benefits were done in patients with fairly severe and active disease. It is reasonable to consider your individual situation:

• Do I have frequent attacks? Since these medications seem to work primarily by reducing the frequency of attacks, patients with frequent attacks are more likely to benefit from treatment than those with attacks every few years pr less. Attacks seem in most studies to be reduced by about a third by each of these treatments.

• Are my attacks severe and / or disabling? The milder the attacks, the less potential benefit from treatment. The more severe the attacks, the greater the benefit from treatment. However, keep in mind that a more severe attack could occur at any time, even if your previous attacks have been mild.

• Do I have active attacks or do I have progressive disease and am no longer having attacks? The interferons (Avonex, Betaseron, and Rebif) and copolymer (Copaxone) work by preventing attacks and have no proven efficacy in progressive disease. Patients with progressive disease need to consider Novantrone or monthly Solumedrol, not interferons and copolymer

Which drug?

Relapsing - Remitting Disease

It can be difficult to make this decision. A consideration of the frequency and route of administration, potential side effects, cost, and potential efficacy need to all be considered.

• Interferon Beta-1-a (Avonex). Avonex is given by intramuscular injection once a week. It can cause flu-like side effects, and possibly may make depression worse. Patients on this medication should have liver testing and blood counts monitored by blood tests every 6 months. Click here for more information about Avonex from the NMSS

• Betaseron. Betaseron is given by subcutaneous injection every other day. It can cause flu-like side effects, and possibly may make depression worse. It can also cause injection site reactions. Patients on this medication should have liver testing and blood counts monitored by blood tests every 6 months. Since it is a higher dose and given more frequently than Avonex, some feel that it might be somewhat more effective, although this view is not accepted universally. Click here for more information about Betaseron from the NMSS

• Galatrimer (Copaxone). This medication is given every day by subcutaneous injection. It is a different type of compound than the other three and does not generally cause flu symptoms or depression. It does not require blood monitoring. It can also cause injection site reactions. Click here for more information about Copaxone from the NMSS

• Rebif. Rebif is given by subcutaneous injection three times a week. It can cause flu-like side effects, and possibly may make depression worse. It can also cause injection site reactions. Patients on this medication should have liver testing and blood counts monitored by blood tests every 6 months. Since it is a higher dose and given more frequently than Avonex, some feel that it might be somewhat more effective, although this view is not accepted universally. It is somewhat more expensive than Betaseron and Avonex and does not appear to offer any particular advantages over these medications. Click here for more information about Rebif from the NMSS

Secondary Progressive Disease

• Novantrone (Mitoxantrone)This is the only FDA approved medication for treatment of secondary progressive MS. It is not generally used for relapsing remitting disease (there may be exceptions) I usually recommend it primarily for patients showing a pretty substantial and / or rapid decline. That's because it can have significant toxicities including suppression of bone marrow, adverse cardiac effects, and nausea. It is given in the chemotherapy infusion center every 3 months, usually after consultation with an oncologist. Because of the potential for cumulative heart toxicity, we can only give it for about 2 years total and then can't use it again. We often will do an echocardiogram tests to be sure heart function is normal before stating this medication. Click here for more information about Novantrone from the NMSS

• Solumedrol (a corticosteroid). One study reported on a treatment for secondary progressive multiple sclerosis with intermittent treatment with intravenous solumedrol. This treatment consisted of an every two month high dose solumedrol infusion followed by a tapering dose of Prednisone (another coricosteroid). The results of the study demonstrated a reduction in the rate of progression in disability and brain atrophy in some patients. This treatment is not FDA approved.

Primary Progressive Disease

Unfortunately, despite several experimental and clinical research trials, there remains no known effective treatment for this disease.