MS Medications: An Overview of DMARDs

MS Medications

Most common Multiple sclerosis (MS) medications include steroids, interferons, and various immune-modulating drugs.

These medications work by suppressing the immune response to reduce inflammation and nerve damage.

In this article, we will look into some effective MS medications, their uses, MOA, and side effects.

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What is Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. A variety of drugs are available to manage its symptoms and slow the progression of the disease. However, until now, there is no drug to cure it.

Commonly used MS Medications include steroids and disease-modifying drugs.

According to studies, the treatment of MS falls into the following categories:

  • Treatment of aggravations
  • Slowing progress with Disease-modifying drugs
  • Symptomatic therapy
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Treatment Options for MS

Here is a list of medications that can be used in the treatment of Multipla sclerosis (MS):

  • Steroids

These include oral prednisolone or IV methylprednisolones, which are used to treat acute relapses of MS.

They reduce the duration of relapse but do not guarantee that the patient will return to their baseline functionality.

Side effects of steroids include infections, osteoporosis, proximal myopathy, impaired glucose tolerance, and a deranged lipid profile.

Disease-modifying drugs:

A class of drugs that are immunomodulators and help slow the frequency and duration of relapse by preventing antibodies from forming against the myelin sheath. Some examples of disease-modifying drugs are:

  • Interferons 

These include interferon beta 1-a, interferon beta 1-b, and peg-interferon beta 1a which are commonly used in MS.

They are used to alleviate the frequency and duration of acute relapses and have particular indications for which they can be used.

Side effects of interferons include flu-like illness, myalgias, fever, hair loss, dizziness, gingivitis, peripheral neuropathy, and visual abnormalities.

  • Glatiramer acetate

It is used to reduce the frequency of relapses and lesions in the brain. Glatiramer acetate binds to the MHC molecules and consequently competes with various myelin antigens for their presentation to T cells.

Side effects of glatiramer acetate include anxiety, bleeding from the mucosa, chest tightness, cough, palpitations, and low-grade fever with chills.

  • Cladribine

Cladribine is used in patients who have not responded to or who were unable to tolerate other potent MS Medications.

It is present in oral formulation taken once a day for 5 days for one month then once a day for the second month.

Cladribine-phosphates act by interfering with DNA synthesis and repair through incorporation into DNA and through inhibition of enzymes involved in DNA metabolism.

Side effects of cladribine include flu-like illness, chest tightness, skin rash, headaches, swelling of eyelids, face, and tongue, and arthralgias.

  • Diroximel fumarate

Diroximel fumarate is indicated for the treatment of relapsing forms of MS in adults. It is considered safer than dimethyl fumarate.

It is said to regulate cell signaling pathways and has neuroprotective effects as a result of its immune-modulatory effects.

Side effects of Diroximel fumarate include leucopenia, progressive multifocal leukoencephalopathy, opportunistic infections, and skin allergic reactions.

  • Fingolimod 

It is used to reduce relapse rates and delay disease progression. It works by trapping lymphocytes in the lymph nodes thereby reducing the number of lymphocytes in the blood and the brain.

Side effects of fingolimod include bradycardia, macular edema, infections, hypertension, and hepatic impairment.

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Summary of MS medications:

DrugIndicationsMechanism of actionPregnancyLactationSide effects
SteroidsAcute exacerbationsImmunosuppression via decreasing the production of antibodies.SafeSafe
  • Infections,
  • osteoporosis,
  • proximal myopathy,
  • impaired glucose tolerance,
  • deranged lipid profile.
InterferonsReduce the frequency and duration of acute exacerbationsInterferes with viral replication, modulates the immune responseAvoidAvoid
  • Flu-like symptoms,
  • depression,
  • hepatic dysfunction,
  • injection site reactions
Glatiramer acetateRelapsing-remitting MSModulates immune responseUse with cautionUse with caution
  • Injection site reactions,
  • systemic hypersensitivity reactions,
  • chest pain,
  • palpitations
Dimethyl fumarateRelapsing-remitting MSMay modulate the immune responseAvoidUse with caution
  • Flushing, gastrointestinal symptoms,
  • lymphopenia,
  • hepatic dysfunction
FingolimodRelapsing forms of MSSphingosine 1-phosphate receptor modulatorAvoidAvoid
  • Macular edema,
  • liver dysfunction,
  • lymphopenia,
  • hypertension, infections
NatalizumabHighly active relapsing-remitting MSTargets α4-integrin and prevents migration of immune cells into CNSAvoidUse with caution
  • Progressive multifocal leukoencephalopathy,
  • hypersensitivity reactions,
  • infections
AlemtuzumabRelapsing-remitting MSDepletes CD52+ lymphocytesAvoidUse with caution
  • Infusion reactions, infections,
  • autoimmune disorders
OcrelizumabRelapsing-remitting MS, primary progressive MSDepletes CD20+ B cellsUse with cautionUse with caution
  • Infusion reactions,
  • infections,
  • malignancy
CladribineRelapsing-remitting MSInduces lymphocyte apoptosisAvoidUse with caution
  • Lymphopenia,
  • infections,
  • malignancy

These medications have different mechanisms of action and may be prescribed individually based on the type and severity of MS in patients, as well as the individual patient’s medical history and preferences.

It is important to work closely with a healthcare provider to determine the best treatment plan for MS.

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What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

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