When should I start?
Some experts say that treatment with a disease modifying drug should begin as soon as possible. This is because studies have shown that nerves can be damaged very early in MS. Others question whether people should be introduced immediately to a routine of injecting drugs. On average, the disease modifying drugs provide only a 30 per cent reduction in relapses. However, the variable ‘natural history’ of MS means that some people may stay well for many years after diagnosis. The drugs can have side effects.
How do I know which one to take?
The decision about which drug to take can only be based on discussion of the issues with your neurologist and MS nurse, and your individual preference, for example, about injecting. You are entitled to participate in the decision making process over which drug to choose. Much will depend on what you think will suit you best and it may help to think about:
• Whether you can commit to regular injections for the foreseeable future
• Which pattern of injections will fit best with your lifestyle
• Whether you will need support with injections, for example, from your partner, a family member or perhaps a practice nurse
There is a website for people who are considering which drugs to take called MS decisions. It may help you decide the factors that matter most to you. It is funded by the Department of Health and developed in conjunction with a number of organisations, including the MS Society.
All four drugs are injected – Rebif, Copaxone and Betaferon under the skin and Avonex into the muscle. The drugs injected under the skin can cause reactions at the site of the injection (reddening, hardening or bruising). Your MS nurse can help you develop good injection technique and the drugs are available in ‘autoinject’ devices to try to make injection easier.
Are there other drugs available?
There are other drugs apart from these 'first-line' treatments that you may be prescribed.
Natalizumab (Tysabri)
Patients with relapsing remitting MS have shown a reduction in relapse rate by around two thirds. Results also show a significant reduction in the rate of disease progression. The European licensing agency has given approval for using Tysabri for people with highly active relapsing remitting MS who have not benefited from beta interferon or for people who have rapidly evolving, severe relapsing remitting MS. Trials have shown that the drug is associated with a small risk of a rare neurological disease called PML.
Campath 1H
Campath 1H is licensed in the UK for the treatment of a type of leukaemia. It is being tested as a potential treatment for MS, but is not currently licensed for MS. Early results from a clinical trial in people newly diagnosed with relapsing remitting MS found that those taking Campath 1H experienced at least a 75 per cent reduction in the risk of relapse, compared to people taking beta interferon. There was also at least a 65 per cent reduction in the risk of disability progression.
Mitoxantrone
The drug mitoxantrone (Novantrone) is approved in the US for treating secondary progressive MS and worsening relapsing remitting MS (when there is not complete remission between relapses). Mitoxantrone is currently licensed in the UK as a cancer-fighting drug but some people with MS in the UK are prescribed mitoxantrone.
Azathioprine
The drug azathioprine (Imuran) is sometimes used to help prevent rejection during transplantation and it is also used in a variety of diseases where the immune system is at fault, like MS. Although not licensed for MS, it has been used as a treatment for MS since the 1960s.
IVIg
IVIg (intravenous immunoglobulin) is not a standard treatment of MS. However, there is some contested evidence that IVIg can reduce MRI activity and relapse rate in MS. It has no effect on secondary progressive MS.
Fingolimod
Researchers have reported results from an early study using the drug Fingolimod (FTY720) in relapsing remitting MS. Fingolimod is taken as a capsule and results showed that, over six months, Fingolimod reduced relapse rates by around 50 per cent. A larger trial is getting underway and a study is also planned in primary progressive MS.
The Multiple Sclerosis Society of Great Britain and Northern Ireland is a charity registered in England and Wales (207495) and Scotland (SCO16433)
