Treatments for Multiple Sclerosis

Medically Reviewed by Shruthi N, MD on August 26, 2024
Written by WebMD Editorial Contributor
10 min read

Although there is currently no cure for multiple sclerosis (MS), current treatments focus on limiting further damage, easing symptoms, and avoiding complications.

If you have a type of multiple sclerosis called relapsing-remitting MS and your condition is acting up, your doctor may first treat you with a disease-modifying drug. These multiple sclerosis treatments slow down the advance of your disease and prevent flare-ups.

The drugs work by curbing the immune system — your body's main defense against germs — so that it doesn't attack the protective coating called myelin that surrounds the nerves. This article details some of the treatment options available for MS.

Disease modifying therapies (DMTs) for MS can positively affect how your disease evolves over time. They can slow the progression of your disease and limit the number of relapses you have and their severity. There are many DMTS available in the form of injections, pills, and intravenous treatments.

Injectables

Some multiple sclerosis treatments come as injections, which are given either under your skin or into a muscle. The shot might make your skin sore, red, itchy, or dimply.

Beta interferons are some of the most common drugs used to treat MS. They make flares less frequent and less severe. They can also cause flu-like symptoms, such as aches, fatigue, fever, and chills, but these should fade within a few months. They may make you slightly more likely to get an infection. That’s because they lower the number of white blood cells, which help your immune system fight illnesses.

Glatiramer (Copaxone, Glatopa) stops your immune system from attacking the myelin that surrounds and protects your nerves. Other injectables include interferon beta-1a (Avonex, Rebif), interferon beta-1b (Betaseron, Extavia), ofatumumab (Kesimpta), and peginterferon beta-1a (Plegridy).

Ofatumumab (Kesimpta) is an injection you give yourself or get from your doctor every 4 weeks. Ofatumumab is used to prevent immune system cells (lymphocytes) from attacking the nerves in your brain and spinal cord. It helps decrease the number of relapses and may prevent or delay disability. This drug may lower your resistance to infections.

Oral multiple sclerosis medications

Cladribine (Mavenclad) is a pill taken once a day for 5 days for a month and once a day again for the second month. You may need another course in a year. It is not for treating relapsing forms of MS, including relapsing-remitting disease and active secondary progressive disease. It can affect your immune system and make you more likely to get other infections, so you will need to be monitored. You could also have hair loss and rashes.

Dimethyl fumarate (Tecfidera) is a tablet you take twice a day. It can lower your immune cells, so the doctor will do regular blood tests to keep an eye on them. The drug's most common side effects are flushing, stomach pain, diarrhea, nausea, and vomiting. An active ingredient similar to the one in Tecfidera is linked to four cases of progressive multifocal leukoencephalopathy (PML), a rare brain infection.

Diroximel fumarate (Vumerity) is similar to Tecfidera. You take a tablet twice daily. The drug is used to treat relapsing forms of MS. Its most common side effects are flushing, redness, itching, rash, nausea, vomiting, diarrhea, stomach pain, or indigestion. Vumerity has been shown to be easier on the stomach than Tecfidera.

Fingolimod (Gilenya) is also a once-daily tablet. If you haven’t had chickenpox, you’ll need a vaccine if you take this medicine. Common side effects include headache, diarrhea, back pain, cough, and abnormal liver tests. Because the medicine may slow your heart rate, your doctor will watch you closely after your first dose. The drug is also linked to PML.

Monomethyl fumarate (Bafiertam) is a pill taken twice per day and is similar to dimethyl fumarate. Common side effects include flushing, belly pain, diarrhea, and nausea. Blood counts and liver enzymes should be monitored.

Ozanimod (Zeposia) is a pill taken once a day. It starts with a low dose and then builds up over the first week. Common side effects include some dizziness, headaches, respiratory infections, and cold symptoms. You shouldn’t take it if you have liver or heart problems.

Ponesimod (Ponvory) is a pill taken daily. It prevents immune system cells (lymphocytes) from attacking the nerves in your brain and spinal cord. It helps decrease the number of disease-worsening episodes (relapses) and prevent or delay disability. This drug may lower your resistance to infections.

Siponimod (Mayzent) is a tablet taken daily after a 5-day buildup to the proper dose. It can affect your immune system and has been linked to clotting in the extremities. The most common side effects are diarrhea, dizziness, swelling in the extremities, high blood pressure, headaches, and a slowed heartbeat. You shouldn't take siponimod if you are pregnant.

Teriflunomide (Aubagio) is a tablet you take once a day. The most common side effects include diarrhea, abnormal liver tests, nausea, and hair loss. It does carry a "black box" warning — the FDA's most serious warning — because it can lead to liver problems and birth defects. If you take it, your doctor will likely do regular tests to check how well your liver is working. Don’t take it if you're pregnant.

IV infusions

Other MS medications are given by IV in a doctor’s office or a hospital. But you only have to go once every few months:

Alemtuzumab (Lemtrada) and mitoxantrone (Novantrone) are chemotherapy drugs designed to treat cancer. They’re an option if you don’t respond to other medications. They curb your immune system and prevent it from attacking nerve coverings. Novantrone has an FDA "black box" warning because it can lead to heart damage and a type of leukemia.

Natalizumab (Tysabri) and ocrelizumab (Ocrevus) are options if other drugs don't work for you. Natalizumab prevents immune cells from getting to your brain and spinal cord, where they can damage nerves. Ocrelizumab attacks certain B cells and stops your immune system from attacking your body. The drugs are linked to PML, so your doctor will do blood tests to check for it.

While MS affects everyone differently, relapsing-remitting MS causes periods of disease flares. You may recover between these flares (also called remission). Sometimes, all your symptoms go away, but at other times a few symptoms may persist.

If you’re taking other medication, mild flares will eventually go away on their own. If they aren’t bothering you, you don't need to treat them. If the symptoms of your flares worsen, your doctor may want to treat them.

Steroids

If a flare gets in the way of your life, your doctor may give you high-dose steroids through a vein (IV) or by mouth to ease your symptoms quickly. These drugs will calm the flare, but they won't slow the course of your disease. The most common ones are:

  • Methylprednisolone (Solu-Medrol)
  • Prednisone (Deltasone)
  • Adrenocorticotropic hormone, or ACTH (H.P. Acthar Gel)

Plasmapheresis

Plasmapheresis uses a medical device to separate your blood into its parts: cells and plasma. The plasma is thrown away and a fluid replacement is combined with your blood cells and reinserted into your body. Plasmapheresis is sometimes used as a multiple sclerosis treatment for patients who can't tolerate high doses of steroids or develop complications from their use. Plasmapheresis takes several hours to complete, and patients typically receive three to seven rounds of treatment.

Your doctor may recommend treatments for:

Muscle stiffness and spasms:

  • Muscle relaxants such as baclofen (Lioresal) and tizanidine (Zanaflex)
  • Sedatives such as clonazepam (Klonopin) and diazepam (Valium)

Fatigue:

  • Amantadine (Symmetrel)
  • Armodafinil (Nuvigil)
  • Modafinil (Provigil)

Depression:

Antidepressants such as bupropion (Wellbutrin), fluoxetine (Prozac), and sertraline (Zoloft)

Bladder problems:

  • Oxybutynin (Ditropan) or tolterodine (Detrol)

Limiting the damage caused by free radicals:

  • Antioxidants such as vitamins A (or better yet, beta-carotene), C, and E limit the damage caused by free radicals, the unstable molecules that can damage cells and in turn cause illness and aging. The best sources of these vitamins are fruits and vegetables.

Metabolic health:

  • Some studies suggest that topically applying magnesium, which assists in the regulation of important bodily functions such as creating energy, nerve signal conduction, and muscle contraction, may ease sore muscles and restore sleep.

Your doctor may recommend physical therapy, especially if you have walking or mobility difficulties. Physical therapy can help strengthen your muscles, improve your balance and posture, and ease fatigue and pain. A trained health care professional can teach you exercises that help you stay active. They can help you improve your walking (gait) and suggest ways for you to live safely and independently with MS. You might also learn how to use a cane, walker, or other assistive device to get around more easily.

Additionally, physical therapists can help prevent complications that arise after a flare-up or periods of reduced mobility that leave you with muscle weakness or contractions.

Medications aren’t the only answer. Taking good care of yourself will help you live better with MS. Every day, make sure you:

Get plenty of rest. Keep a regular sleep schedule and make sure your bedroom is cool, dark, and screen-free.

Eat healthy food. There is no "MS diet." Choose foods low in saturated fats and high in fiber. The U.S. Department of Agriculture’s MyPlate website is a good starting point.

Get some exercise. Even a walk around the block can help. Exercise builds bones and strengthens muscles. It keeps depression at bay and helps you sleep better.

Physical therapy. A trained health care professional can teach you exercises that help you stay active. You might also learn how to use a cane, walker, or other assistive device to get around more easily.

Manage your stress. It may make your symptoms worse. Whether you meditate, read, journal, or chat with friends, find something that helps you control the ups and downs.

Stay cool. A rise in body temperature can make your symptoms worse. Stay in the AC if you can. Wear loose, breathable clothes outside.

Many products claim to help with MS symptoms. Be wary of those that make claims that seem too good to be true and don’t have scientific studies backing them. Talk to your doctor about anything you’re tempted to take. Some supplements can change the way your medicines work.

Current research suggests these treatments are worth a try:

Vitamin D. Low levels of vitamin D in your blood can boost your chances of having MS. Studies are underway to see if vitamin D supplements can help. You should get your doctor to check your levels and discuss if you need to take a supplement.

Vitamins B9 (folic acid) and B12. These B vitamins contribute to nervous system health. Certain studies have shown that low vitamin B12 levels may be more prevalent in people with MS. Ask your doctor to check your B12 levels to see if treatment may be needed.

Cranberry juice. People with MS are prone to developing urinary tract infections (UTIs). Regularly drinking cranberry juice or eating foods rich in Vitamin C can help flush harmful bacteria out of your urinary system.

Acupuncture. This traditional Chinese treatment is based on the belief that energy called chi flows along your body in lines called meridians. When your chi is out of whack, it results in illness or pain. An acupuncturist slides thin needles into points along the meridians to change your energy flow. Studies show it can help MS symptoms such as fatigue, pain, mood, spasticity, numbness, tingling, and bladder problems.

 

Currently, there's no cure for multiple sclerosis. But very effective treatments are available now to manage your symptoms, prevent complications, and limit flares and additional nerve damage. In addition to medications that treat relapses and modify the course of your disease (DMTs), there are several supportive treatments such as occupational and physical therapy, counseling, and types of symptom management that can enhance your quality of life.

What is the best treatment for multiple sclerosis?

Multiple sclerosis is currently incurable. But treatment focuses on quick recovery after flares, reducing the possibility of relapse, managing symptoms, and slowing disease progression. Treatments typically include corticosteroids, disease-modifying therapies (DMTs), and plasmapheresis (plasma exchange).

How much do multiple sclerosis treatments cost?

Treating multiple sclerosis costs a great deal for patients and communities. Individually, the nearly 1 million people with MS pay an average annual cost of more than $88,000 for the various treatment options, devices, daily living needs, and insurance needed for their condition. Overall, indirect costs due to sick days and early retirement amount to nearly $21 billion a year.

Can you live with MS without medication?

You may prefer to see how your condition progresses before starting medications to treat your MS. A small percentage of people with MS have a mild form of the disease and do fine without treatment, but this is not the case for most. Instead of medicine, you might try physical or occupational therapy or corticosteroids first to manage your disease. As always, it's best to discuss your treatment options with a doctor.

What is the biggest challenge facing treatment for multiple sclerosis?

Although there isn't yet a cure for multiple sclerosis, the many new treatment options around DMTs, better supportive care, and earlier detection have led to greatly improved outcomes for people with MS. However, the biggest challenges doctors face in treating MS are the health risks associated with disease modifying therapies. Some DMTS may not work as well on older patients or those with other health issues such as cancer, liver, kidney disease, or HIV. Other DMTs may impact pregnancy or breastfeeding.

What is the first-line treatment for multiple sclerosis?

Corticosteroids and plasmapheresis (plasma exchange) are the primary treatments for MS flares. Early and aggressive treatment with DMTs can reduce the possibility of relapse, slow further development of lesions, and limit the impact of MS on your brain and body.

How long would you need to get MS treatment?

Without a cure, you may need some sort of treatment for MS or its complications for life, but earlier treatment may slow the progression of the disease. According to one study, patients treated with DMTs within 6 months of their first MS flare were 45% less likely to progress to moderate disability than those who waited a year and a half for treatment.

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