Can medications prevent MS relapses?

Looking for a way to reduce relapses? There are medications that can make relapses less frequent. They are known as disease-modifying medications, and there are 8 available in Canada: Avonex® (interferon beta-1a), Betaseron® (interferon beta-1b), Copaxone® (glatiramer acetate), Extavia® (interferon beta-1b), Gilenya® (fingolimod), Rebif® (interferon beta-1a), Tecfidera™ (dimethyl fumarate), and Tysabri® (natalizumab). Disease-modifying medications can reduce relapse rates by about one-third.

How do these medications lower the risk of relapses? During a relapse, immune system cells known as T cells enter the brain, where they damage the myelin coating of nerve cells. T cells do their damage by producing harmful chemicals and by stimulating other cells to attack the myelin.

  • Interferons (interferon beta-1a and interferon beta-1b) work by blocking stimulation and growth of T cells and by making it more difficult for T cells to enter the brain.
  • Glatiramer is believed to work by changing the actions of T cells. It is thought that it changes T cells so that instead of causing damage, they actually reduce inflammation in the brain.
  • Fingolimod is believed to work by altering the way the body's immune system works. In MS, when white blood cells (lymphocytes) reach the brain and spinal cord, they are thought to cause the inflammation that contributes to the loss of myelin. Fingolimod may keep lymphocytes from reaching the brain and spinal cord.
  • Natalizumab works by preventing cells of the active immune system from reaching the brain.
  • It is unclear exactly how dimethyl fumarate works, but it is thought to stop immune cells and could be protective against damage to the brain and spinal cord.

All but two of the disease-modifying medications are given by injection. Avonex® is given once weekly into a muscle. Betaseron® and Extavia® are given under the skin every other day. Copaxone® is given under the skin each day. Rebif® is given under the skin 3 days a week. Tysabri® is given as an intravenous (IV) infusion (a slow injection into a vein) once every 4 weeks. Gilenya® is an oral capsule and is taken by mouth once a day. Tecfidera™ is taken by mouth twice a day.

  • Avonex®: flu-like symptoms, muscle aches, fever, chills, and weakness
  • Betaseron®: flu-like symptoms, injection-site reactions (irritation of skin around the area where the medication was injected), injection-site tissue changes, fever, chills, headache, and allergic reactions
  • Copaxone®: injection-site reactions, vasodilation (widening of blood vessels), chest pain, weakness, infection, pain, nausea, joint aches, and anxiety
  • Extavia®: injection site reactions, flu-like symptoms, rash, and fluid retention (swelling) in ankles or legs
  • Gilenya®: flu-like symptoms, headache, diarrhea, back pain, cough, and abnormal liver function tests
  • Rebif®: flu-like symptoms, weakness, fever, chills, joint aches, muscle aches, headaches, and injection-site reactions
  • Tecfidera™: flushing, diarrhea, nausea, and stomach pain
  • Tysabri®: dizziness, fever, headache, joint pain, nausea, vomiting, stuffy nose, sore throat, tiredness, and urinary tract infection

Talk to your doctor or pharmacist to find out more information on these medications and whether one may be right for you.

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