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Unfortunately, current treatments are unable to cure this disease, although they are capable of improving your quality of life.
Treatment protocols employ three different approaches:
- When you experience a flare-up, you will generally be prescribed corticosteroids. These medications, used as a bolus (a bolus in an injection of a significant dose of a substance into a vein), have anti-inflammatory and anti-pain effects. Due to these properties, they serve to decrease the intensity and duration of multiple sclerosis symptoms, while reducing the duration of inflammatory response.
In times when you are not experiencing flare-ups, in other words, while you are in remission, you will take other medications that will affect the progression of your disease. These disease-modifying treatments serve to decrease frequency of flare-ups while delaying the onset of physical disabilities. These treatments are indicated from the beginning stage of your disease, for a period of several years. Their mechanisms of action allow for their direct action on the immune system, thereby reducing inflammation. Two routes of administration are available for these drugs: oral and by injection.
- The final approach to treatment serves to alleviate the symptoms associated with the disease (pain, fatigue, depression, stiffness, urinary problems, etc.). This strategy may employ the use of drugs but may also employ paraclinical methods (physical therapy, speech therapy, psychotherapy, etc.). This serves to reduce everyday discomfort, thereby improving your quality of life.
Oral and injectable MS drugs
The French National Agency for Medicines and Health Products Safety (ANSM) has granted marketing authorisations (MAs) for three oral medications:
- Tecfidera (dimethyl fumarate) has been granted an MA for the treatment of adults with relapsing-remitting MS (RRMS). In some individuals, this drug may cause gastrointestinal problems and hot flashes, which generally lessen over time. This drug is effective for reducing the frequency of flare-ups, decreasing the risk of developing physical disabilities and reducing the number of active lesions visible in MRIs.
- Aubagio (teriflunomide) has a marketing authorisation for the same indications and possesses the same adverse side effects as Tecfidera®. In some uncommon situations, it may result in loss of hair thickness.
- Gylenia (Fingolimod) is indicated as a single-drug disease-modifying drug for highly active forms of RRMS. This medication requires cardiology follow-up during use.
Injectable MS drugs:
- During the early stages, glatiramer acetate (Copaxone) is prescribed to patients who are just starting to develop RRMS, as a first line of treatment. This medication has an immunomodulating effect, serving to decrease the frequency and severity of flare-ups while also reducing lesions encountered in MRI. After receiving an injection, some irritation may appear at the injection site.
- Another widely prescribed class of drugs are beta interferons (Betaferon, Extavia, Rebif and Avonex). They are similar in effect to Copaxone®, even though they work through a different mechanism of action. Upon first starting treatment, it is possible that you may experience fever, chills or muscle pain. These symptoms generally go away with time.
Two other molecules are indicated for highly inflammatory (aggressive) forms of MS. These drugs are Elsep or Novantrone (Mitoxantrone) and Tysabri (Natalizumab).
- Elsep or Novantrone (Mitoxantrone) are administered intravenously as infusions in combination with a corticosteroid to reduce toxicity. For the entire duration of your treatment, your blood will be monitored (blood cell count) and you will receive echocardiograms.
- Tysabri (Natalizumab) is a humanised monoclonal antibody that is administered as an infusion for a minimum of one hour, solely in hospital environments. It has been proven to be effective at reducing the number of flare-ups per year, delaying the development of physical disabilities, and significantly lowering the number of lesions that show up in MRIs. It also has a beneficial impact on patients’ quality of life.
Sources:
- HAS
- ARSEP
- VIDAL
- ANSM
- Eurekasanté
Last updated: 19/06/2018
