There are many issues for the patient and physician to consider in treating multiple sclerosis. Goals may include:
- improving the speed of recovery from attacks (treatment with steroid drugs)
- reducing the number of attacks or the number of MRI lesions
- attempting to slow progression of the disease (treatment with disease modifying drugs or DMDs)
An additional goal is relief from complications due to the loss of function of affected organs (treatment with drugs aimed at specific symptoms).
Most neurologists will consider treatment with DMDs once the diagnosis of relapsing remitting multiple sclerosis is established. Many will begin treatment at the time of the first multiple sclerosis attack, since clinical trials have suggested that patients in whom treatment is delayed may not benefit as much as patients who are treated early.
It is important for patients to talk to their doctor before deciding to go on therapy since DMDs differ in their uses (for example, one DMD may be used for slowing progressing disability but not for treatment of the first attack of MS; another DMD may be used for reducing relapses but not for slowing progressing disability). Finally, utilizing support groups or counseling may be helpful for patients and their families whose lives may be affected directly by multiple sclerosis.
Once goals have been set, initial therapy may include medications to manage attacks, symptoms, or both. An understanding of the potential side effects of drugs is critical for the patient because sometimes side effects alone deter patients from drug therapy.
Drugs known to affect the immune system have become the primary focus for managing multiple sclerosis. Initially, corticosteroids, such as prednisone (Deltasone, Liquid Pred, Deltasone, Orasone, Prednicen-M) or methylprednisolone (Medrol, Depo-Medrol), were widely used. However, since their effect on the immune system is non-specific (general) and they may use may cause numerous side effects, corticosteroids now tend to be used to manage only severe multiple sclerosis attacks (that is, attacks leading to physical disability or causing pain).
Interferons for relapsing multiple sclerosis
Since 1993, medications that alter the immune system, particularly interferons, have been used to manage multiple sclerosis. Interferons are protein messengers that cells of the immune system manufacture and use to communicate with one another. There are different types of interferons, such as alpha, beta, and gamma. All interferons have the ability to regulate the immune system and play an important role in protecting against intruders including viruses. Each interferon functions differently, but the functions overlap. The beta interferons have been found useful in managing multiple sclerosis.
- Interferon beta-1b (Betaseron®) was the first interferon approved in the U. S. to manage RR-MS in 1993.
- In 1996, intramuscular interferon beta-1a (Avonex®) gained FDA approval for RR-MS.
- Subcutaneous Interferon beta-1a (Rebif®) was approved in the U. S. in 2002.
- The FDA also approved the marketing of Interferon beta-1b under the brand name Extavia® in 2009.
Overall, patients treated with interferons experience fewer relapses or a longer interval between relapses. Avonex® and Rebif® are used to slow progressing disability. The most common side effect is a flu-like syndrome that includes fever, tiredness, weakness, chills, and muscle aches. This syndrome tends to occur less frequently as therapy continues. Other common side effects are injection site reactions, changes in blood cell counts, and abnormalities of liver tests. Regular liver tests and blood counts are recommended for patients receiving beta-interferons. Periodic thyroid function testing also is recommended because of the effects of beta-interferons on the thyroid gland. With the concomitant use of analgesics and evolving nursing experience with managing local skin reactions, the tolerability to interferons seems to have improved over the years.
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