Multiple sclerosis (MS) is a disabling disease that affects the spinal cord and the brain. In people with multiple sclerosis, the immune systems start to attach the protective covering of the nerves in the body, causing damage to the nerves. Due to this damage, communication problems develop between the brain and the rest of the body. The symptoms of MS vary from person to person, depending on the extent of nerve damage and which nerves are affected. There is no cure for multiple sclerosis, but there are many types of treatments available for helping relieve the symptoms of MS. Some treatments, such as infused medications, can help slow down the progress of MS.
Treatment with infused drugs has also shown to not only alleviate symptoms but also reduce potential damage done by flare-ups of the disease. Let’s take a closer look at infusion treatments for multiple sclerosis and their side effects.
Treating Multiple Sclerosis
Multiple sclerosis (MS) is a disabling autoimmune disease that affects the spinal cord and the brain, or the body’s central nervous system. In people with multiple sclerosis, the immune system starts to attack the protective covering of the nerves, known as myelin. (1)
Over a period of time, MS damages or completely destroys this protective coating, leading to communication problems between the brain and the rest of the body. If the disease is left untreated, then it can eventually destroy not just the myelin of the surrounding nerves, but also start to cause damage to the nerves themselves.
While there is no cure for multiple sclerosis, there are many new and promising treatments available that slows down the progression of MS. Treatment can help alleviate your symptoms and also decrease the potential damage caused by flare-ups of the disease. Flare-ups are a term used to refer to the periods when you experience the symptoms of multiple sclerosis.
However, the treatment for multiple sclerosis varies during the period when you are experiencing a flare-up. When you are having a flare-up of MS, at that time, you will need to take another type of medication known as a disease modifier, which changes the way in which the disease behaves. These medications also help slow down the progression of MS and also reduces the severity of the flare-up.
Some of these disease-modifying treatments are available as infused medications, which have been found to be especially beneficial to people who have advanced or aggressive multiple sclerosis.
Infusion Treatment for Multiple Sclerosis
As of today, there are four infusible drugs that have been approved for the treatment of multiple sclerosis. Let us take a look at each of them.
Alemtuzumab (brand name: Lemtrada)
- Doctors prescribe Lemtrada (alemtuzumab) to patients who have so far not responded well to at least two of the other types of MS medications.
- Alemtuzumab functions by gradually lowering the body’s number of B and T lymphocytes, which are types of white blood cells present in the body. This reduction of B and T lymphocytes helps reduce inflammation and also reduces the damage caused to nerve cells.
- You will receive this medication once a day for five days, and then after the first treatment, you will receive the medication once a day for three days straight. (2)
Natalizumab (brand name: Tysabri)
Tysabri (natalizumab) functions by stopping the damage-causing immune cells from entering into the spinal cord and brain. This drug will be administered once in every four weeks. (3)
Mitoxantrone Hydrochloride
- Mitoxantrone hydrochloride is not just an infusion treatment for multiple sclerosis, but it is also a chemotherapy medication used for treating cancer. (4)
- This medication works best in people who have secondary progressive multiple sclerosis (SPMS) or rapidly progressing multiple sclerosis. This is because the medicine is an immunosuppressant, meaning that it works towards stopping the immune system’s reaction to the MS flare-ups. This decreases the symptoms of a flare-up.
- This medication is given once every three months for a lifetime. The maximum cumulative dosage of the drug is 140 mg/m2, and it is reached within two to three years.
- Due to the risk of severe side effects associated with mitoxantrone hydrochloride, it is only prescribed to people with severe multiple sclerosis.
Ocrelizumab (brand name: Ocrevus)
- Ocrevus (ocrelizumab) is one of the newest additions to infusion treatment for multiple sclerosis. The drug was approved by the US Food and Drug Administration (FDA) in 2017 only. (5)
- This medication is used in the treatment of the primary progressive type of multiple sclerosis, or relapsing MS. In fact, Ocrevus is one of the first drugs to be approved for the treatment of primary progressive multiple sclerosis (PPMS). (6)
- Ocrevus functions by targeting the B lymphocytes (a type of white blood cell) in the body that are causing damage to the myelin sheath. In the beginning, the drug is administered in two 300mg infusions in a span of two weeks. After this, it is administered in 600mg infusions once every six months.
Side Effects of Infusion Treatments
There are many known side effects of infusion treatment for multiple sclerosis. In fact, the very process of infusion can cause certain side effects, including:
- Chills
- Bruising or bleeding at the injection site
- Reddening and warming, or flushing, of the skin
- Nausea
You are also have an adverse infusion reaction, which is a reaction of the drug on your skin. For all the infusion drugs, this infusion drug reaction is more likely to develop within the first two hours of receiving the treatment, though the response can even occur up to 24 hours later. Some of the symptoms of an infusion reaction may include:
- Rash
- Hives
- Scaly patches on the skin
- Fever or warmness
Then there are side effects associated with each of the infused drugs. These include:
Alemtuzumab Side Effects
The most commonly observed side effects of this medication include: (7)
- Rash
- Nausea
- Fatigue
- Urinary tract infection (UTI)
- Headache
- Fever
- Common cold
In some cases, this medication can also lead to some very serious and potentially fatal side effect, such as:
- Cancer
- Blood disorders
- Autoimmune reactions such as organ failure and Guillain-Barre syndrome
Natalizumab Side Effects
The most commonly observed side effects of natalizumab include:
- Allergic reactions
- Headache
- Infections
- Depression
- Fatigue
Some of the more severe side effects of natalizumab include:
Liver problems that can lead to symptoms like:
- Dark or brown urine
- Yellowing of the skin
- Yellowing of the whites of the eyes
- Pain in the upper right side of the abdomen
- Fatigue
Rare and fatal brain infection known as progressive multifocal leukoencephalopathy (PML)
Mitoxantrone Hydrochloride Side Effects
The most common side effects associated with mitoxantrone hydrochloride are:
- Depression
- Bone pain
- Low levels of white blood cells, which increases the risk of infections
- Hair loss
- Urinary tract infection
- Amenorrhea, a condition characterized by a lack of menstrual periods
- Nausea or vomiting
More severe side effects of this medication include:
Getting too much of this medication puts you at a high risk of side effects, which can prove to be highly toxic for the body. This is why mitoxantrone hydrochloride is only advised for people who have severe MS. These side effects can also include blood issues apart from kidney failure and congestive heart failure. While you are undergoing infusion treatment with mitoxantrone, your doctor will monitor you very closely for symptoms of any side effects.
Ocrelizumab Side Effects
The commonly observed side effects of ocrelizumab include:
- Infusion reactions
- Infections
The potentially severe side effects of ocrelizumab may consist of:
- Cancer, including breast cancer
- Reactivation of shingles of hepatitis B, but only if they are already present in your body
- A weakened immune system
- Progressive multifocal leukoencephalopathy, which is a deadly brain infection
Conclusion
There are many cases of multiple sclerosis where the doctor recommends infusion treatments such as the ones discussed above or other infusion treatments. These other infusion treatments may be used for treating MS relapses that are not responding to corticosteroids. These infusion treatment options may include plasmapheresis, a technique that involves removing blood from the body, running it through a filter for eliminating antibodies that could be attacking your nervous system, and then sending the cleansed blood back into the body with a transfusion. Intravenous immunoglobulin (IVIG) is also another infusion treatment used for multiple sclerosis. In this, an injection is given to help boost and activate the immune system.
Infusion treatments can definitely be an excellent treatment option to help treat the symptoms of MS and for reducing the flare-ups. However, infusion drugs are not the right choice for every MS patient since there is a risk of serious complications associated with these medications. Nevertheless, many people with multiple sclerosis have found these treatments to be of great help.
If you are looking for a better way of managing your symptoms, or if you have progressive multiple sclerosis, then it is a good idea to discuss the possibility of infusion treatments with your doctor.
- Goldenberg, M.M., 2012. Multiple sclerosis review. Pharmacy and Therapeutics, 37(3), p.175.
- Coles, A.J., Twyman, C.L., Arnold, D.L., Cohen, J.A., Confavreux, C., Fox, E.J., Hartung, H.P., Havrdova, E., Selmaj, K.W., Weiner, H.L. and Miller, T., 2012. Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy: a randomised controlled phase 3 trial. The lancet, 380(9856), pp.1829-1839.
- Polman, C.H., O’Connor, P.W., Havrdova, E., Hutchinson, M., Kappos, L., Miller, D.H., Phillips, J.T., Lublin, F.D., Giovannoni, G., Wajgt, A. and Toal, M., 2006. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. New England Journal of Medicine, 354(9), pp.899-910.
- Marriott, J.J., Miyasaki, J.M., Gronseth, G. and O’Connor, P.W., 2010. Evidence Report: The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 74(18), pp.1463-1470.
- Montalban, X., Hauser, S.L., Kappos, L., Arnold, D.L., Bar-Or, A., Comi, G., De Seze, J., Giovannoni, G., Hartung, H.P., Hemmer, B. and Lublin, F., 2017. Ocrelizumab versus placebo in primary progressive multiple sclerosis. New England Journal of Medicine, 376(3), pp.209-220.
- Kappos, L., Li, D., Calabresi, P.A., O’Connor, P., Bar-Or, A., Barkhof, F., Yin, M., Leppert, D., Glanzman, R., Tinbergen, J. and Hauser, S.L., 2011. Ocrelizumab in relapsing-remitting multiple sclerosis: a phase 2, randomised, placebo-controlled, multicentre trial. The Lancet, 378(9805), pp.1779-1787.
- Österborg, A., Karlsson, C., Lundin, J., Kimby, E. and Mellstedt, H., 2006, April. Strategies in the management of alemtuzumab-related side effects. In Seminars in oncology (Vol. 33, pp. 29-35). WB Saunders.
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