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Disease modifying therapies

Disease modifying therapies (DMTs) aren't a cure for MS, but they can reduce how many relapses someone has and how serious they are. They can also slow down the damage caused by relapsing multiple sclerosis that builds up over time.

There are over a dozen DMTs for MS available on the NHS. They are taken either as a pill, an injection or an infusion.

Explore them all on this page and find out which is right for you.

Find information about MS treatments during the COVID-19 pandemic

Explore disease modifying treatments for MS

Alemtuzumab (Lemtrada)

The European Medicines Agency (EMA) has reviewed the safety of alemtuzumab following reports of rare side effects.

Across the UK you can take alemtuzumab if you have relapsing MS and:

  • despite already taking a DMT, you’ve still had a recent relapse and MRI scans show new signs that your MS is active (you have new lesions),

           or

  • you’ve had 2 relapses in the last year and you have new lesions on your MRI scans (whether you’re already on a DMT or not.

Most people have two courses of treatment spaced a year apart from each other. It's given through a drip (known as an infusion) in hospital. For the first course you go to hospital five days in a row. Each day you have an infusion that takes about four hours. You might go home every day two hours after your infusion or you may stay in hospital for the length of the treatment.

You have the second course a year later, over three days in a row, again for about four hours each day. For some people a third (or even fourth) course is needed. Again, this will be over three days in a row, for about four hours each day.

Read more about alemtuzumab

Avonex (interferon beta-1a)

In ScotlandNorthern Ireland and Wales you can have Avonex (a brand name for one of the beta interferon drugs) if:

  • you have relapsing MS and you’ve had a recent relapse and/or MRI scans show new signs that your MS is active (you have new lesions)

In England you can have this drug if:

  • you’ve had two relapses in the last two years
  • you’ve had one relapse in the last two years and MRI scans show new signs that your MS is active (you have new lesions)

Across the UK you can have this drug if:

  • you have a clinically isolated syndrome or CIS (a first attack of MS-like symptoms) and a brain scan shows you’re likely to go on to get MS

It’s injected into the muscle once a week.

Read more about the beta interferons

Betaferon (interferon beta-1b)

In ScotlandNorthern Ireland and Wales you can have Betaferon (a brand name for one of the beta interferon drugs) if:

  • you have relapsing MS and you’ve had a recent relapse and/or MRI scans show new signs that your MS is active (you have new lesions)

In England you can have Betaferon if:

  • you’ve had two relapses in the last two years
  • you’ve had one relapse in the last two years and MRI scans show new signs that your MS is active (you have new lesions)

It’s injected under the skin every other day.

Read more about the beta interferons

Cladribine (Mavenclad)

You can take cladribine (its brand name is Mavenclad) if:

  • you have ‘highly active’ relapsing MS. This means you’ve had two or more disabling relapses in the past year and MRI scans show you have more, or bigger, lesions. Guidelines call this ‘rapidly evolving severe relapsing remitting MS’

          or

  • despite taking a DMT, you’ve had a relapse in the past year and new or bigger lesions can be seen on your MRI scans

You take this drug as a tablet in two courses. Each treatment course consists of two treatment weeks, one at the beginning of the first month and one at the beginning of the second month. This is then repeated a year later. Hopefully the two courses will control your MS and you won’t need any more treatment.

Read more about cladribine

Daclizumab (Zinbryta) - withdrawn

Daclizumab (its brand name is Zinbryta) was withdrawn from the market on Friday 2 March 2018 after safety concerns. Anyone taking daclizumab should talk to their neurologist about treatment options.

Dimethyl fumarate (Tecfidera)

In ScotlandWales and Northern Ireland you can have dimethyl fumarate (its brand name is Tecfidera) if:

  • you have relapsing MS and you’ve had a recent relapse and/or MRI scans show new signs that your MS is active (you have new lesions)

In England you can have this drug if:

  • you’ve had two relapses in the last two years

It’s a tablet you take twice a day.

Read more about dimethyl fumarate

Extavia (beta interferon-1b)

In ScotlandNorthern Ireland and Wales you can have Extavia (a brand name for one of the beta interferon drugs) if:

  • you have relapsing MS and you’ve had a recent relapse and/or MRI scans show new signs that your MS is active (you have new lesions)

In England you can have this drug if:

  • you’ve had two relapses in the last two years
  • you’ve had one relapse in the last two years and MRI scans show new signs that your MS is active (you have new lesions)
  • you have secondary progressive MS but you still have significant relapses (at least two in the last two years)

 It's injected under the skin every other day.

Read more about the beta interferons

Fingolimod (Gilenya)

In Scotland and Wales you can have fingolimod (its brand name is Gilenya) if:

  • you have highly active relapsing remitting MS and another DMT hasn’t worked for you or
  • you’ve had two or more disabling relapses in one year and an MRI scan shows you’re getting more lesions

In England and Northern Ireland you can have it if:

•    you have the same or an increased number of relapses despite treatment with beta interferons (Avonex, Rebif, Betaferon, Extavia and Plegridy),  glatiramer acetate (Copaxone), dimethyl fumarate (Tecfidera) or teriflunomide (Aubagio)

Across the UK:

You might be switched to fingolimod if you’re taking natalizumab (Tysabri) and are at high risk of developing the brain infection PML.

Fingolimod can also be used as your first DMT if you have highly active relapsing MS  or rapidly evolving severe relapsing remitting MS.

It’s a tablet you take once a day.

Read more about fingolimod

Glatiramer acetate (Copaxone)

In ScotlandWales and Northern Ireland you can have glatiramer acetate (its brand name is Copaxone) if:

  • you have relapsing MS and you’ve had a recent relapse and/or MRI scans show new signs that your MS is active (you have new lesions)

In England you can have this drug if:

  •  you’ve had two relapses in the last two years
  • you’ve had one relapse in the last two years and MRI scans show new signs your MS is active (you have new lesions)

Across the UK you can have this drug if:

  • you have a clinically isolated syndrome or CIS (a first attack of MS-like symptoms) and a brain scan shows you’re likely to go on to get MS.

It's injected under the skin using a pre-filled syringe once a day or three times a week.

Read more about glatiramer acetate

HSCT

Haematopoietic stem cell transplantation (HSCT) is an intense chemotherapy treatment for MS.

It aims to stop the damage MS causes by wiping out and then regrowing your immune system, using your stem cells.

Read more about HSCT

Natalizumab (Tysabri)

In ScotlandWales and Northern Ireland you can have natalizumab (its brand name is Tysabri) if:

  • you have relapsing MS and you’ve had a relapse in the last year and MRI scans show new signs that your MS is active (you have new lesions). This is despite taking another DMT
  • you have relapsing MS and you’ve had at least two relapses in the last year and MRI scans show new signs that your MS is active. This is happening whether or not you’ve been taking another DMT  

In England you can have this drug if:

  • you have relapsing MS and you’ve had at least two relapses in the last year and MRI scans show new signs that your MS is active. This is happening whether or not you’ve been taking another DMT  

Natalizumab is given through a drip (known as an infusion), which takes about an hour, with another hour to be monitored. You need to go to hospital once every four weeks for the infusion, but you don't need to stay overnight.

Read more about natalizumab

Ocrelizumab (Ocrevus)

Ocrelizumab is used to treat active relapsing MS or early primary progressive MS.

You’re given this drug through a drip (known as an infusion) in hospital once every six months.

Relapsing MS

In England, Scotland, Wales and Northern Ireland you can take ocrelizumab (its brand name is Ocrevus) if:

  • you've got ‘active relapsing MS’. This means you’re having relapses or MRI scans show new lesions
  • and you qualify to take alemtuzumab (Lemtrada) but that drug isn’t suitable for you

So, ocrelizumab is an alternative to alemtuzumab if you can’t take that drug for some reason, or you have worries about its side effects and risks.

Primary progressive MS

Since 2020 ocrelizumab is recommended across the UK to treat people if they have early primary progressive MS.

The following all also need to be true for you:

  • your MRI scans show signs of inflammation. In particular, you need a scan to show you have a T1 gadolinium-enhancing lesion. Or you need two or more scans that show you have new or growing T2 lesions
  • you have a score on the Expanded Disability Status Scale (EDSS) between 3.0 and 6.5. A score over 6.5 means you use a wheelchair all the time. People aren’t given DMTs, including ocrelizumab, if they’ve been using a wheelchair for at least six months. This is because there’s not enough evidence at the moment that DMTs will make enough difference to their MS.

What is ‘early’ primary progressive MS?

If you have primary progressive MS, your neurologist will decide if it’s ‘early’ or not based on how long you’ve had symptoms, and how much disability it’s caused you.

For primary progressive MS to be classed as ‘early’ - and for you to qualify to get ocrelizumab - your neurologist will follow this rule:

  • if your EDSS score is over 5, your MS symptoms must not have started longer than 15 years ago
  • if your score is 5 or under, your symptoms must not have started longer than 10 years ago.

The EDSS measures how much MS affects you, focusing on how well you can walk.

Read more about Ocrelizumab

Plegridy (peginterferon beta 1a)

In ScotlandNorthern Ireland and Wales you can have Plegridy (a brand name for one of the beta interferon drugs) if:

  • you have relapsing MS and you’ve had a recent relapse and/or MRI scans show new signs that your MS is active (you have new lesions)

In England you can have Plegridy if:

  • you’ve had two relapses in the last two years
  • you’ve had one relapse in the last two years and MRI scans show new signs that your MS is active (you have new lesions)

Across the UK you can have this drug if:

  • you have a clinically isolated syndrome or CIS (a first attack of MS-like symptoms) and a brain scan shows you’re likely to go on to get MS

It's injected under the skin every two weeks.

Read more about the beta interferons

Rebif (beta interferon-1a)

In ScotlandNorthern Ireland and Wales you can have Rebif (a brand name for one of the beta interferon drugs) if:

  • you have relapsing MS and you’ve had a recent relapse and/or MRI scans show new signs that your MS is active (you have new lesions)

In England you can have these drugs if:

  • you’ve had two relapses in the last two years
  • you’ve had one relapse in the last two years and MRI scans show new signs that your MS is active (you have new lesions)

It's injected under the skin three times a week.

Across the UK you can have this drug if:

  • you have a clinically isolated syndrome or CIS (a first attack of MS-like symptoms) and a brain scan shows you’re likely to go on to get MS

Read more about the beta interferons

Teriflunomide (Aubagio)

In ScotlandWales and Northern Ireland you can take teriflunomide (its brand name is Aubagio) if:

  • you have relapsing MS and you’ve had a recent relapse and/or if MRI scans show new signs that their MS is active (you have new lesions)

In England you can have this drug if:

  • you’ve had two relapses in the last two years

It’s a tablet that you take once a day.

Read more about teriflunomide

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