Multiple sclerosis: how is treatment with drugs

Although there is no cure for multiple sclerosis, there are medications that help in the treatment, reducing inflammatory activity and outbreaks over time, thus decreasing the symptoms of physical disability characteristic of the disease.

Generally, treatment for multiple sclerosis includes:

• Remedies that reduce the risk of outbreaks by reducing the activity of immune system cells; Remedies that treat acute outbreaks, which reduce acute inflammation, such as corticosteroids; Remedies used in symptomatic therapy, which serve to relieve symptoms of disease and improve the quality of life.

Remedies that prevent disease progression

When determining the treatment, the doctor must take into account factors such as the efficacy and safety of the medication, the person's profile and other treatments that he is undergoing, but above all the clinical form of the disease.

1. Interferon beta

Beta interferon is one of the most prescribed immunomodulatory remedies to treat multiple sclerosis, which reduce the frequency and severity of outbreaks.

The most common side effects include reaction at the injection site, characteristic flu symptoms, such as fever, headache, sneezing and runny nose and liver damage, so blood tests should be carried out to monitor liver enzymes.

Some people taking this medicine may develop antibodies that can reduce the effectiveness of other drugs.

2. Ocrelizumab

Ocrelizumab, with the trade name Ocrevus, is a humanized recombinant monoclonal antibody that acts by modulating the immune system, but its mechanism of action is still unknown.

The most common side effects that can be caused by this medicine are reactions at the injection site, lowering blood pressure, fever and nausea. In addition, it can also increase the risk of cancer, namely breast cancer. Learn more about this medicine.

3. Glatiramer acetate

Glatiramer acetate is composed of a set of synthetic polypeptides capable of regulating the immune system, helping to block the attack of the immune system on myelin.

The most common side effects include irritation at the injection site, infection, anxiety, depression, headache, feeling unwell, joint and back pain, and feeling weak.

4. Dimethyl fumarate

This is a remedy that prevents the immune system from damaging the brain and spinal cord, which helps to slow the worsening of the disease

The most common side effects that can occur during treatment are diarrhea, nausea and a decrease in the number of white blood cells in the blood.

5. Fingolimod

Fingolimod is a medicine that helps to reduce the number of recurrences, delaying the symptoms of the disease. This medicine can change the way the immune system works, preventing inflammatory cells from reaching the brain, which reduces nerve damage caused by multiple sclerosis.

The most common side effects that can occur with the use of this medication are headache, high blood pressure, blurred vision and reduced heart rate, so it is important to monitor the heart a few hours after the first dose.

6. Teriflunomide

Studies show that teriflunomide, commercially known as Aubagio, significantly reduces the occurrence of outbreaks, the risk of disability progression and the inflammatory activity of the lesions. Learn more about this medicine.

The most common side effects that can occur during treatment are liver damage and hair loss. This medication is harmful to the developing fetus and therefore should not be used by women who are pregnant or wish to become pregnant and in this case, it should also not be used by the male partner.

7. Natalizumab

Natalizumab, known commercially as Tysabri, is a humanized monoclonal antibody that blocks the movement of potentially harmful immune cells from the bloodstream to the brain and spinal cord.

The most common side effects that can be caused by this medication are headache, tiredness, infections, depression and pain in the extremities. This medication increases the risk of a viral brain infection called progressive multifocal leukoencephalopathy in some people.

8. Alemtuzumab

This medication helps to reduce the potential nerve damage caused by white blood cells, but on the other hand, it increases the risk of infections and autoimmune disorders.

The most common side effects that can occur with the use of this remedy are reactions associated with infusion, infections and thyroid disorders.

9. Mitoxantrone

Commercially known as Mitostate, this immunosuppressant inhibits the proliferation of T and B lymphocytes, the production of antibodies by B cells and the destruction of macrophage-mediated myelin.

This medication can be harmful to the heart and is associated with the development of cancer in the blood and therefore its use in the treatment of multiple sclerosis is extremely limited. Mitoxantrone is generally used only to treat the disease at a severe and advanced stage or for people who have not responded to other treatments.

In the table below are listed all types of Multiple Sclerosis and the drugs usually prescribed for each of them:

Isolated clinical syndrome	Outbreak-remission (SR)	Rapidly evolving severe SR	Progressive secondary with outbreaks	Recurrent Progressive
Interferon beta	Interferon beta	Natalizumab	Interferon beta	Mitoxantrone
Glatiramer acetate	Glatiramer acetate	Fingolimod	Mitoxantrone
Teriflunomide	Teriflunomide	Alemtuzumab (2nd line)
	Dimethyl fumarate
	Alemtuzumab
	Natalizumab (2nd line)
	Fingolimod (2nd line)
	Alemtuzumab (2nd line)

Medicines used to treat acute episodes

When an outbreak of multiple sclerosis occurs, medications that act to control acute inflammation, such as corticosteroids, should be administered.

Corticosteroids, such as oral prednisone and intravenous methylprednisolone, are prescribed to reduce nerve inflammation. The most common side effects of these medications can include insomnia, increased blood pressure, mood swings and fluid retention.

Remedies used in symptomatic treatment

For people suffering from multiple sclerosis, in addition to treatment with drugs that delay the symptoms of the disease, a healthy lifestyle should be promoted through an adapted diet, regular physical activity when tolerated, physical therapy, correction of vitamin deficiency D and omega 3 supplementation.

Watch the following video and see how to do the exercises recommended for multiple sclerosis:

In addition, it is very important to control the symptoms that arise through symptomatic therapy. These symptoms usually include muscle contractions, tiredness, weakness, pain, sexual dysfunction, depression and uncontrolled bladder and bowel:

• Lack of motor coordination and tremors: clonazepam; Involuntary increase in muscle contractions: baclofen, diazepam, tizanidine, dantrolene, cyclobenzaprine hydrochloride; Weakness: aminopyridine, diaminopyridine, fampridine; Pain: anticonvulsants, such as carbamazepine, phenytoin, gabapentin, pregabalin, antidepressants such as amitriptyline, nortriptyline, desipramine, venlafaxine or antiarrhythmic agents such as mexiletine; Urinary dysfunction: propanthelin bromide, oxybutynin, tolterodine tartrate or solifenacin; Depression: fluoxetine, sertraline, amitriptyline, nortriptyline, desipramine, venlafaxine; Tiredness: amantadine, methylphenidate, modafinil; Cognitive problems: donepezil hydrochloride; Sexual dysfunction: sildenafil, tadalafil, vardenafil.

The treatment for multiple sclerosis must be established by the doctor and the person must be monitored frequently in order to adapt the medications according to the evolution of the disease. It is important that the person never self-medicates, even if any of the symptoms mentioned above occurs.