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Drugs for Multiple Sclerosis Patients: What You Need to Know

Debra Gordon

Last updated: October 20, 2016 7:31 pm

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Multiple sclerosis (MS) is one of the most common autoimmune diseases, affecting an estimated 2.3 million people around the world. 1

The disease results from the immune system attacking the central nervous system’s myelin (a fatty substance that covers and protects nerves) and nerves. This can affect the brain’s communication with the body, especially regarding vision, sensation, mobility, control of bladder and bowels, and cognition (including memory).

While a few patients experience only one or two attacks or flare-ups, some have a form called primary progressive MS, in which their symptoms of MS and disability worsen without remission.

Most, however, have a form called “relapsing-remitting,” in which they enter a period of remission between attacks. Over time, the attacks may decrease and the neurological damage slows as the disease moves into secondary progressive MS. 2

Medications for Multiple Sclerosis

Until fairly recently, treatment consisted mainly of reducing inflammation and managing symptoms, primarily with corticosteroids. None, however, halted disease progression.

Then several disease-modifying therapies entered the market, most of them biologic drugs that act directly on the immune system to stem the progression of the disease. 3

Though effective for many, these drugs also carry the risk of significant side effects, some of which can be life-threatening.

One of these side effects is a potentially fatal viral disease, progressive multifocal leukoencephalopathy (PML). PML is a rare and serious brain infection caused by the John Cunningham (JC) virus. 4 5

PML can be notoriously hard to detect early, because its symptoms can be confused with those of the neurological degeneration associated with MS. In addition, the virus worsens when a patient is given corticosteroids, a medication that can commonly be used to tame autoimmune flare-ups, such as those experienced with MS.

The virus is harmless in people with healthy immune systems, but can cause infection in those with suppressed immune systems. 6 Most treatments for MS suppress the immune system. 7

Here’s what you need to know about some of the specific medications available:

  • Tysabri (natalizumab). This was the first monoclonal antibody approved for MS. However, like several disease-modifying therapies for MS, Tysabri carried a risk of PML. In addition, Tysabri may also cause a rarer, but still serious form of cancer called primary CNS lymphoma. 8
  • Gilenya (fingolimod). Like the other disease-modifying drugs, Gilenya reduces white blood cell count, increasing the risk of infections such as shingles. It is also associated with serious heart conditions. At least one case of PML has occurred in a patient receiving Gilenya. 9
  • Aubagio (teriflunomide). This medication can, in rare cases, lead to liver failure. It also carries an increased risk of infection, including PML. 10
  • Tecfidera (dimethyl fumarate). Tecfidera reduces immune function by about 30 percent, increasing the risk of infection and particularly PML. In late November 2014, the FDA issued a warning about a patient with MS who had taken Tecifdera for four years and died from PML. 11
  • Lemtrada (alemtuzumab). This is the most recently approved disease-modifying therapy for MS. It carries a risk of several serious conditions including immune thrombocytopenia and anti-glomerular basement membrane disease, both of which may be fatal. Lemtrada may also increase the risk of certain cancers and can result in life-threatening reactions during infusion. 12

Given the serious risk of infections, cancer, cardiovascular abnormalities and other side effects from these medications, it is important that you and your doctor discuss the risks and benefits of each drug before choosing a treatment.

In addition, your doctor should monitor your blood levels and other clinical indicators while you are receiving these medications. Finally, tell your doctor immediately about any fevers, unusual symptoms, lumps, or persistent changes in cognition or mobility, including sudden weakness or paralysis.

  1. What is MS. National Multiple Sclerosis Society. Available at: http://www.nationalmssociety.org/What-is-MS/Who-Gets-MS#section-2 . Accessed January 19, 2015. 

  2. Curtin F, Hartung HP. Novel therapeutic options for multiple sclerosis. Expert Rev Clin Pharmacol. 2014;7(1):91-104. 

  3. Curtin F, Hartung HP. Novel therapeutic options for multiple sclerosis. Expert Rev Clin Pharmacol. 2014;7(1):91-104. 

  4. Curtin F, Hartung HP. Novel therapeutic options for multiple sclerosis. Expert Rev Clin Pharmacol. 2014;7(1):91-104. 

  5. FDA warns about case of rare brain infection PML with MS drug Tecfidera (dimethyl fumarate). FDA Drug Safety Communication. Food and Drug Administration. November 25, 2014. 

  6. FDA warns about case of rare brain infection PML with MS drug Tecfidera (dimethyl fumarate). FDA Drug Safety Communication. Food and Drug Administration. November 25, 2014. 

  7. Curtin F, Hartung HP. Novel therapeutic options for multiple sclerosis. Expert Rev Clin Pharmacol. 2014;7(1):91-104. 

  8. Curtin F, Hartung HP. Novel therapeutic options for multiple sclerosis. Expert Rev Clin Pharmacol. 2014;7(1):91-104. 

  9. Curtin F, Hartung HP. Novel therapeutic options for multiple sclerosis. Expert Rev Clin Pharmacol. 2014;7(1):91-104. 

  10. Curtin F, Hartung HP. Novel therapeutic options for multiple sclerosis. Expert Rev Clin Pharmacol. 2014;7(1):91-104. 

  11. FDA warns about case of rare brain infection PML with MS drug Tecfidera (dimethyl fumarate). FDA Drug Safety Communication. Food and Drug Administration. November 25, 2014. 

  12. LEMTRADA [prescribing information]. Cambridge, MA:Genzyme. 2014.