What Are the Treatments for Relapsing Remitting Multiple Sclerosis?

Relapsing Remitting Multiple Sclerosis (MS) is a chronic condition that affects the central nervous system. Nearly 85% of people diagnosed with MS have relapsing remitting MS. This is an episodic disease, characterized by periods of disease activity (relapse) and periods of disease inactivity (remission). Essentially, the insulating membranes surrounding the nerves (myelin) is damaged by the patient's immune system. Long-term treatment strives to lessen the frequency and severity of these episodes.

History

• MS has long been studied, but effective treatments were not approved by the FDA until 1993. Because the course of the disease can be unpredictable, studies last for years in order to prove that positive changes are due to the drug being studied rather than the natural course of the disease. The first successful trial of a treatment for MS was for Betaseron, an interferon. William Sibley, an MS researcher, noted that after 50 years of research his most exciting day was when Betaseron's effectiveness was proved. Several other treatments were approved in the years that followed and research continues to search for more effective treatments.

Types

• Treatments for Relapsing Remitting MS can be roughly categorized as follows: treatment for acute episodes, long term disease modifying treatment, and symptom management. As much of the disease's damage in the relapsing remitting form is due to inflammation, it is important to reduce inflammation as quickly as possible in an acute attack (when new symptoms appear and interfere with daily activities). This treatment usually involves IV steroids and is administered for a limited time on a outpatient basis. Patients also can take disease modifying drugs (such an interferons) to lesson the frequency and severity of episodes. These treatments are self-administered injections that are taken daily, every third day or weekly on an ongoing basis. With Relapsing Remitting MS some function does not return during a period of remission. These ongoing disabilities are treated on a case-by-case basis.

FDA Approved Treatments

• The FDA has approved six medications for the treatment of Relapsing Remitting MS. Upon diagnosis, most MS patients are recommended to begin long term treatment with one of four disease modifying drugs (Avonex, Betaseron, Copaxone and Rebif). All four are injectable medications; Copaxone, Betaseron and Rebif are subcutaneous injections (into the fatty layer just below the skin) while Avonex is injected into the muscle. Tysabri is a treatment with more side effects that is only recommended for people who have not seen significant benefit from the 4 generally prescribed treatments. Novatrone is a chemotherapy drug that is used for patients whose MS is worsening despite use of other treatments.

Alternative Medicine

• Many MS patients supplement or replace traditional medical approaches with alternative medicine. The use of yoga, meditation, and exercise are currently being studied as treatments for relapsing remitting MS. Some patients follow a diet regime that restricts things thought to cause inflammation, such as gluten. Evidence in this area is often largely anecdotal but, as promoting general well-being is in itself an effective treatment, patients are often encouraged to try treatments that appeal to them.

Considerations

• MS treatment decisions are difficult ones. Each treatment has side effects that must be considered. Are the frequent flu-like symptoms an acceptable trade-off for the long term positive effects of interferons? Are daily injections a realistic treatment option? Some patients with little or no apparent disease activity opt not to take disease modifying drugs for these and other reasons because the payoff is not immediately clear. Unfortunately, disease activity is not always apparent. Patients with no symptoms may still have new lesions on their brain or spine. Early treatment is necessary to prevent future disability and the earlier it is begun, the better.