MS Drugs Compared

We don’t have a cure for multiple sclerosis. But the FDA has approved more than a dozen drugs that can slow, or “modify,” the course of your MS. They may ease your symptoms, keep your disease from getting worse sooner, and make relapse attacks less frequent.

You take them in one of three ways: as pills, injections, or infusions into a vein. Some may work better for you than others. They can cause different or different degrees of side effects.

Almost all of the medications are for the most common type of MS, called relapsing-remitting MS (RRMS). Two drugs treat more advanced forms of the disease.

Doctors use certain drugs to treat a return, or “relapse,” of MS symptoms. Other drugs slow the progression of the disease. A third group of drugs treats specific symptoms of MS.

Medications for MS Relapses

MS relapses -- also called exacerbations, attacks, or flare-ups -- are when symptoms return. These might be new symptoms that you haven’t had before or old symptoms that come back or worsen.

If symptoms are serious enough to interfere with your ability to function, like loss of balance or vision, doctors may prescribe a short course of high- dose corticosteroids. This helps lessen inflammation and tends to shorten the relapse. A 3- or 5-day course of intravenous corticosteroids like methylprednisolone (Solu-Medrol) or an oral version like prednisone (Deltasone) usually does the trick.

Other treatments for relapses include:

H.P. Acthar Gel. it's a type of adrenocorticotropic hormone (ACTH) that releases slowly into your system after injection. It’s not always easy to get and can be expensive. You and your doctor might consider it if corticosteroids don't work well for you.

Plasmapheresis. This means a machine replaces the plasma portion of your blood with an equivalent fluid. Doctors consider this in serious cases that don’t respond to steroid treatment.

Medications for MS Disease Progression

The FDA has approved the following medications to lower the number of MS relapses, slow the onset of disability, and perhaps lessen new disease activity. Some doctors also prescribe “off-label” meds -- those that have been approved for other conditions. Injectable medications

• Glatiramer acetate (Copaxone)
• Interferon beta-1a (Avonex, Rebif)
• Interferon beta-1b (Betaseron, Extavia)
• Ofatumumab (Kesimpta)
• Peginterferon beta-1a (Plegridy)

Oral medications

• Cladribine (Mavenclad)
• Dimethyl fumarate (Tecfidera)
• Diroximel fumarate (Vumerity)
• Fingolimod (Gilenya)
• Monomethyl fumarate (Bafiertam)
• Ozanimod (Zeposia)
• Siponimod (Mayzent)
• Teriflunomide (Aubagio)

Infused medications

Infused medications are delivered through a needle into your vein or under your skin.

• Alemtuzumab (Lemtrada)
• Mitoxantrone (Novantrone)
• Natalizumab (Tysabri)
• Ocrelizumab (Ocrevus)

Read below to find out more about the way these drugs work and how they compare to each other.

Alemtuzumab (Lemtrada)

How it works: The FDA approved this powerful, long-lasting drug to treat MS in 2014. It’s a monoclonal antibody, which means it can find and target specific immune cells to keep them from damaging nerves. Alemtuzumab can cause dangerous or deadly side effects. Your doctor probably won’t prescribe this until you’ve tried at least two other MS drugs.

How you take it: By IV infusion once a day for 5 days, then 1 year later for 3 days.

Side effects: You’ll need close monitoring, including regular blood tests for at least 5 years. This drug can lead to a rare and deadly bleeding condition. It also can affect your kidneys. About 1 in 3 users can get thyroid disease. You may have a serious reaction to the infusion. Most common side effects include:

• Headache
Rash
• Nausea
• Fever

Cladribine (Mavenclad)

How it works: A disease modifier, cladribine is for treating relapsing forms of MS including relapsing-remitting disease and active secondary progressive disease. It attacks the part of your blood that is attacking the myelin that protects your nerves.

How you take it: Once a day for 5 days for the first month. Once a day for 5 days the second month.

Side effects:

• Low white blood cell count
• Hair loss
Rash
• Higher risk of tuberculosis
• Mouth sores or shingles

Dimethyl Fumarate (Tecfidera)

How it works: Researchers think this pill may block immune cells that damage your nerves. It may also act like an antioxidant to help protect your brain and spinal cord. Doctors have long used it to treat psoriasis, another autoimmune disorder.

How you take it: One capsule twice a day.

Side effects: It can affect your blood counts, so your doctor will check those every few months. You also might have swelling in your throat and tongue, which can make it hard to breathe. You might have some digestive problems, like:

• Nausea
• Diarrhea
• Abdominal pain
• Flushing, like a hot flash

Fingolimod (Gilenya)

How it works: This was the first pill approved for MS. It binds to white blood cells and traps them in your lymph nodes so they can’t do damage in your central nervous system. It can help lower the number of MS relapses. It may work about as well as interferon beta, although the evidence is limited.

How you take it: One capsule a day. Because fingolimod can sometimes cause a slower heart rate, your doctor will probably keep close tabs on it, especially when you start.

Side effects: This drug can cause birth defects. You shouldn't take it if you’re pregnant or plan to be. You also may be more likely to get an infection or have swelling in your eyes that can affect your vision. Other issues to watch for include:

• Headache
Flu
• Diarrhea
• Back pain
• Liver problems
• Sinus infections
• Abdominal pain
• Pain in your hands and feet
• Cough

Glatiramer Acetate (Copaxone, Glatopa)

How it works: It’s a lab-made protein that may protect against cells that damage myelin, the protective layer for your nerves. The drug makes relapses happen less often.

How you take it: A shot in the arm, abdomen, hip, or thigh once a day or three times a week, depending on your dose.

Side effects: Serious problems are uncommon, but you may get:

• Redness, pain, or swelling where the shot went in
• Flushed skin
• Shortness of breath
Rash
• Chest pain
• A fast or uneven heartbeat
• Anxiety

Interferon Beta (Avonex, Betaseron, Extavia, Plegridy, Rebif)

How it works: These are lab-made versions of your body’s infection-fighting protein. They’ve been around the longest and are the most widely prescribed drugs for MS. They’re a type of drug called biologics, which are made with living cells. Doctors aren’t sure, but they think interferon betas turn down signals in your body that trigger the autoimmune response that leads to MS.

How you take them: One injection with a prefilled autoinjector pen or a syringe every other day or once a week, depending on the drug. Pegylated interferon beta-1a (Plegridy) stays active in your body longer than others, so you take it less often.

Side effects: They can include:

• Headache
• Flu-like symptoms
• Pain where the shot went in your body
• Low white blood cell count
• Bruising or bleeding more easily
• Liver problems
• Seizures
• Feelings of depression and suicidal thoughts

Any side effects may bother you less if you have your shot at bedtime. You can take pain and fever relievers, like acetaminophen or ibuprofen, before each injection and during the 24 hours afterward to help relieve some of these problems.

You shouldn’t take these drugs if you have an allergy to interferon beta or albumin, the main protein in blood plasma.

Interferon drugs can cause depression or make it worse. They can also affect your blood cells and how your liver and thyroid gland work.

Mitoxantrone (Novantrone)

How it works: This is a former cancer drug that was approved for MS. It weakens your immune system to lower the number of cells that attack your myelin. It’s the only drug besides Ocrevus that’s prescribed for a progressive form of MS, specifically secondary progressive MS. That’s when your condition worsens beyond RRMS.

How you take it: One infusion every 3 months, with up to 12 doses over 2 or 3 years.

Side effects: Because of safety worries, doctors usually prescribe this only if your MS is growing worse quickly and if other drugs haven’t helped. It can seriously affect your heart and may make you more likely to get blood cancer.

It’s harder for your body to fight off infection when you take Novantrone, so stay away from sick people. Let your doctor know right away if you have:

• Fever or chills
• Sore throat or cough
• Sores on lips or in mouth
• Shortness of breath
• Stomach pain, vomiting, or diarrhea
• Painful or difficult urination
• Uneven or rapid heartbeat
• ankles-and-feet' target='_blank' rel='noopener noreferrer' >Swollen feet or ankles
• Unusual bleeding or bruising
• Pain, swelling, redness, or irritation at the injection site

You may have other side effects that go away as your body adjusts to the drug. They include:

• A blue-green color of urine for 24 hours after receiving Novantrone
• Mild or moderate nausea
• Menstrual changes in women
• Mild to moderate hair loss (hair usually grows back after treatment ends)

Natalizumab (Tysabri)

How it works: This antibody drug sticks to T cells and keeps them from reaching your brain and spinal cord and attacking the protective myelin. It’s usually prescribed if your relapsing MS is highly active or if you didn’t respond to other MS drugs.

How you take it: By infusion once every 28 days in an infusion clinic.

Side effects: It’s rare, but you can get a brain infection that can lead to disability or death. The symptoms at first may look like an MS relapse. Some people can be allergic to the drug. Common side effects include:

• Joint pain
• Fever
• Feeling sick or tired
• Headache or dizziness

Ocrelizumab (Ocrevus)

How it works: The FDA approved it in 2017. It treats RRMS as well as primary progressive MS (PPMS). That’s when your condition gets steadily worse without periods of relapses and remissions. Ocrelizumab is a monoclonal antibody and targets B cells that damage nerves. Studies show that it may work better to lower relapses and to slow your MS than some interferon beta drugs.

How you take it: Two infusions 2 weeks apart, every 6 months.

Side effects: You should not take it if you have hepatitis B. As with other infusion drugs, you may get itchy skin, a rash, throat irritation, or an allergic reaction. Rarely, you can get a fatal brain infection.

Siponimod (Mayzent)

How it works: Siponimod is an immune system-modulating drug that enters the central nervous system and helps control inflammation. It helps your body’s lymph nodes retain certain white blood cells, stopping them from circulating throughout the body and into the central nervous system.

How you take it: You begin slowly and raise your dosage over time, starting with 0.25 milligrams for the first 2 days, then 0.50 milligrams on day 3, 0.75 on day 4, up to 1.25 milligrams on day 5, and up to 2 milligrams as maintenance thereafter.

Side effects: Side effects include disorders of the nervous system and as infections. The most common side effects include:

• Diarrhea
• Dizziness
• Swelling in extremities
• Arm or leg pain
• Slowed heart rate
• High blood pressure
• Headaches

Teriflunomide (Aubagio)

How it works: This drug blocks enzymes that activate your white blood cells. This slows down the production of the immune cells that are active when MS is damaging your nerves.

How you take it: One tablet a day.

Side effects: It can cause major birth defects. If you’re pregnant or thinking about getting pregnant, you shouldn’t take it. Your doctor also will need to monitor you closely for any liver, kidney, or nerve damage, as well as infections and high blood pressure. Other issues include:

• Diarrhea
• Nausea
• Thinning hair

Medications for MS Symptoms

Bladder problems

• Darifenacin (Enablex)
• Desmopressin (DDAVP Nasal Spray)
• Imipramine (Tofranil)
• Mirabegron (Myrbetriq)
• Onabotulinumtoxin A (Botox)
• Oxybutynin (Ditropan, Oxytrol)
• Prazosin
• Solifenacin succinate (Vesicare)
• Tamsulosin (Flomax)
• Tolterodine (Detrol)

Bowel problems

• Bisacodyl (Dulcolax)
• Docusate (Colace, Enemeez)
• Gylcerin
• Magnesium hydroxide (Phillips Milk of Magnesia)
• Mineral oil
• Psyllium hydrophilic mucilloid (Metamucil)
• Sodium phosphate (Fleet Enema)

Infection

• Ciprofloxacin (Cipro)
• Levofloxacin (Levaquin)
• Methenamine (Hiprex)
• Nitrofurantoin (Macrodantin)
• Phenazopyridine (Pyridium)
• Sulfamethoxazole (Bactrim, Septra)

Depression and emotional problems

• Sertraline (Zoloft)
• Fluoxetine (Prozac)
• Duloxetine (Cymbalta)
• Bupropion (Wellbutrin)
• Citalopram (Celexa)
• Velafaxine (Effexor)
• Paroxetine (Paxil)
• Dextromethorphan/quinidine (Nuedexta)

Tiredness

• Methylphenidate (Ritalin)
• Dextroamphetamine/amphetamine (Adderall)
• Fluoxetine (Prozac)
• Amantadine
• Modafinil (Provigil)

Pain

• Amitriptyline (Elavil)
• Carbamazepine (Tegetrol)
• Duloxetine (Cymbalta)
• Gabapentin (Neurontin)
• Hydroxyzine (Vistaril) for itching
• Lamotrigine (Lamictal)
• Nortriptyline (Aventyl, Pamelor)
• Oxcarbazepine (Trileptal)
• Pregabalin (Lyrica)
• Velafaxine (Effexor)

Sexual problems

• Alprostadil (MUSE, Prostin VR)
• Avanafil (Stendra)
• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra)

Muscle control, tremors, and balance

• Baclofen
• Clonazepam (Klonopin) for tremors
• Dalfampridine (Ampyra) for walking and balance problems
• Dantrolene (Dantrium)
• Diazepam (Valium)
• Isoniazid (Laniazid/Nydrazid) for tremors
• Meclizine (Antivert) for dizziness and vertigo
• Onabotulinumtoxin A (Botox)
• Tizanidine (Zanaflex)

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