Multiple sclerosis (MS) is an autoimmune disease in which your immune system starts to ‘eat’ away the protective covering that surrounds your nerves. This protective sheath is known as myelin, and it covers the nerve fibers. Damage to the myelin sheath causes communication problems between the brain and the other parts of the body. Over time, MS can lead to permanent damage or deterioration of the nerves. There is no cure for MS, but there are many different types of treatments that can slow down the progression of the disease. Treatments also help reduce the severity of the symptoms as well as the potential damage caused during MS flares. Infused medications is a commonly used disease-modifying therapy today. These infusion treatments work by changing how the disease behaves and can help in slowing down the progression of MS and also reduce the incidences of flare-ups.
Overview of Multiple Sclerosis
Multiple sclerosis (MS) is a long-lasting and progressive autoimmune disease that affects the spinal cord, the brain, and even the optic nerves in the eyes. MS is known to cause problems with muscle control, with vision, balance, and many other basic body functions.
As MS impacts the CNS, it disrupts the flow of information not just within the brain, but also between the brain and body. The effects of MS are different for each person, and while some people have mild symptoms that do not require any treatment, others have trouble doing simple everyday tasks.
MS is an autoimmune disease that is known to affect the central nervous system (CNS). When you have MS, your immune system starts to attack the body’s nerves, destroying the myelin that protects these nerves. If MS is left untreated, MS can go on to destroy all the myelin that surrounds the nerves. Then the disease will begin harming the nerves themselves.(1)
Treatment of Multiple Sclerosis (MS)
While there is no cure available for MS, there are many types of treatments that help manage the condition. In some cases, treatment is used for slowing down the progression of the disease. Treatment will also help reduce the severity of your symptoms and also reduce any potential damage that is caused to your nerves by a flare-up of MS. Flare-ups are known as the periods during which you experience aggravated symptoms of the disease.(2)
While most treatments are used to help manage overall symptoms, but when you experience a flare-up, then you will need to take another type of medication known as a disease modifier. Disease modifiers help change the manner in which the disease behaves. They can also help with slowing down the progression of MS and also reduce the occurrence of flare-ups.(3)
Many of the disease-modifying therapies are available in the form of infused medications. These infusion treatments are particularly helpful for people who have advanced or aggressive MS.(4)
What are Infusion Treatments for MS?
Infusion treatments deliver medication into the body with the use of a catheter or a needle, usually through a vein. These treatments are also known as drips.
There is a range of infusion therapies available for the treatment of MS and infusion can be used for delivering a number of these drugs.
One category of infusion treatments for MS involves disease-modifying therapies that help slow down disease progression and also slows down MS activity.
Another category of infusion treatments for MS is known as therapies for relapses, which help you control the flare-ups. These medications can help reduce the severity and the length of a relapse. They also help patients manage their symptoms.
Infusion Treatments for MS
As of today, there are four major drugs that are used in infusion treatment for MS. Each of these is discussed below.
Brand Name: Lemtrada (Alemtuzumab)
Lemtrada (alemtuzumab) is prescribed to patients who have already tried out two other MS medications and have not responded well to them.(5)
Lemtrada functions by slowly lowering the number of T and B lymphocytes in the body. T and B lymphocytes are different types of white blood cells (WBCs). Reduction in the number of T and B lymphocytes helps reduce inflammation and also decreases the damage caused to nerve cells.
You need to take the medication once a day for five days. After you complete one year from your first treatment, you will start receiving the drug once a day for three days.
Mitoxantrone Hydrochloride (brand name: Novantrone)
Mitoxantrone hydrochloride is another MS infusion treatment and also a chemotherapy medication that is used for treating cancer.
This treatment is known to work best for people who are having secondary progressive MS (SPMS) or rapidly worsening MS.(6) This infusion treatment works because it is an immunosuppressant, meaning it works to stop the reaction of your immune system that causes it to trigger the MS attacks. This effect is also going to decrease your symptoms during a flare-up.
You will need to receive this drug once in every three months for a lifetime maximum cumulative dose that can be reached within two to three years. The maximum cumulative dose is approximately 140 mg/m2.
Because of the risk of severe side effects associated with this infusion treatment, it is only advisable for people who have severe MS.(7)
Brand Name: Tysabri (Natalizumab)
Tysabri functions by stopping the immune cells from entering your spinal cord and brain. Tysabri is prescribed once every four weeks.(8)
Brand Name: Ocrevus (Ocrelizumab)
Ocrevus is one of the newest infusion treatment that is prescribed for MS. The drug was recently approved by the US Food and Drug Administration (FDA) in 2017 itself.(9)
Ocrevus is used for treating primary progressive forms of MS or the relapsing type of MS. In fact, this drug is the first one to be approved for the treatment of primary progressive MS (PPMS).(10)
This drug is believed to function by targeting the B lymphocytes that help the body with myelin sheath wear and tear.
The medication is initially prescribed in two 300-milligram infusions that are separated by two weeks. After that, it is given once every six months in a dosage of 600-milligram infusions.(11)
In some rare cases, though, your doctor might recommend that you try out some other infusion treatments. These infusion treatments are usually used for treating relapses that are not responding to corticosteroids. These include plasmapheresis, a process that involves removing blood from the body, then filtering it to get rid of any antibodies that might be attacking your nervous system, and also sending the ‘cleansed’ blood back into your body through the process of transfusion.
These other infusion treatments can also include intravenous immunoglobulin (IVIG), which is an injection that helps activate your immune system.
Side Effects of Infusion Treatments for MS
Infusion therapy for MS is known to have quite a few side effects. In fact, the infusion process itself is known to cause side effects such as:
- Bruising or bleeding at the site of infusion
- Flushing or the reddening/warming of the skin
- You can also develop an infusion reaction, which is a drug reaction that occurs on your skin.
For all these four drugs, an infusion reaction is more likely to take place within the first two hours after administration. However, it is also possible for some people to have a reaction up to 24 hours later as well. Symptoms of an infusion reaction may include:
- Skin may feel flushed or warm
- Scaly patches on your skin
Side Effects from the Infusion Drugs
Each of the four infusion drugs that are used in the treatment of MS is known to have their own possible side effects.
Some of the common side effects of alemtuzumab can include:(12)
Lemtrada is also known to cause some very severe side effects that can even be fatal. These can include:
- Blood disorders
- Autoimmune reactions such as organ failure and Guillain-Barre syndrome
The common side effects associated with mitoxantrone hydrochloride include: (13)
- Bone pain
- Nausea or vomiting
- Hair loss
- Urinary tract infection
- Low levels of WBCs, which increases the risk of infections
- Amenorrhea, a condition marked by a lack of menstrual periods
The severe side effects of this infusion drug can include:
Receiving too much of Novantrone is also going to put you at a high risk of certain side effects that can prove to be very toxic to the body. This is why mitoxantrone is usually only prescribed in the very severe cases of MS. These side effects can include:
- Blood issues
- Kidney failure
Your doctor will keep a close eye on you and will continue to monitor you for any signs of potential side effects during the time period of treatment with this drug.
The commonly observed side effects of natalizumab can include:(14)
- Allergic reactions
Some of the more severe side effects of taking Tysabri may consist of:
Liver problems that may manifest symptoms such as:
- Dark or brown-colored urine
- Yellowing of the whites of your eyes or your skin
- Pain in the upper right corner of the abdomen
- Bruising or bleeding that happens more easily than it would normally
- Progressive Multifocal Leukoencephalopathy (PML), which is a rare and deadly brain infection(15)
The common side effects associated with this medication include:(16)
- Infusion reactions
The more serious side effects of ocrelizumab include:
- Cancer, especially breast cancer
- Weakened immune system
- Reactivation of shingles or hepatitis B, but only if they are already present in your system
Infusion treatments can help treat the symptoms of MS as well as the flare-ups. However, infusion drugs are not for everyone. There are several risks associated with infusion treatments, and some of the complications can be quite serious. Nevertheless, many people find them to be helpful in managing their condition.
If you suffer from progressive MS or if you are looking for a better treatment for managing your symptoms, then you should enquire about infusion treatments from your doctor. Your doctor will help you decide if these medications are a good option for your individual condition.
- nhs.uk. (2019). Multiple sclerosis – Treatment. [online] Available at: https://www.nhs.uk/conditions/multiple-sclerosis/treatment/ [Accessed 17 Aug. 2019].
- Pandit, L. and Murthy, J.M.K., 2011. Treatment of multiple sclerosis. Annals of Indian Academy of Neurology, 14(Suppl1), p.S65.
- England.nhs.uk. (2019). [online] Available at: https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2019/03/Treatment-Algorithm-for-Multiple-Sclerosis-Disease-Modifying-Therapies-08-03-2019-1.pdf [Accessed 17 Aug. 2019].
- De Angelis, F., John, N.A. and Brownlee, W.J., 2018. Disease-modifying therapies for multiple sclerosis. bmj, 363, p.k4674.
- Willis, M.D. and Robertson, N.P., 2015. Alemtuzumab for the treatment of multiple sclerosis. Therapeutics and clinical risk management, 11, p.525.
- Mssociety.org.uk. (2019). Secondary progressive MS. [online] Available at: https://www.mssociety.org.uk/about-ms/types-of-ms/secondary-progressive-ms [Accessed 17 Aug. 2019].
- Kingwell, E., Koch, M., Leung, B., Isserow, S., Geddes, J., Rieckmann, P. and Tremlett, H., 2010. Cardiotoxicity and other adverse events associated with mitoxantrone treatment for MS. Neurology, 74(22), pp.1822-1826.
- Selewski, D.T., Shah, G.V., Segal, B.M., Rajdev, P.A. and Mukherji, S.K., 2010. Natalizumab (Tysabri). American journal of neuroradiology, 31(9), pp.1588-1590.
- Frampton, J.E., 2017. Ocrelizumab: first global approval. Drugs, 77(9), pp.1035-1041.
- National Multiple Sclerosis Society. (2019). Primary progressive MS (PPMS). [online] Available at: http://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS [Accessed 17 Aug. 2019].
- Mulero, P., Midaglia, L. and Montalban, X., 2018. Ocrelizumab: a new milestone in multiple sclerosis therapy. Therapeutic advances in neurological disorders, 11, p.1756286418773025.
- infusion, G. and Lemtrada, B. (2019). Common Side Effects of Lemtrada (Alemtuzumab Injection for Intravenous Infusion) Drug Center – RxList. [online] RxList. Available at: https://www.rxlist.com/lemtrada-side-effects-drug-center.htm [Accessed 17 Aug. 2019].
- concentrate, G. and Novantrone, B. (2019). Common Side Effects of Novantrone (Mitoxantrone for Injection Concentrate) Drug Center – RxList. [online] RxList. Available at: https://www.rxlist.com/novantrone-side-effects-drug-center.htm [Accessed 17 Aug. 2019].
- natalizumab, G. and Tysabri, B. (2019). Common Side Effects of Tysabri (Natalizumab) Drug Center – RxList. [online] RxList. Available at: https://www.rxlist.com/tysabri-side-effects-drug-center.htm [Accessed 17 Aug. 2019].
- Astrom, K.E., Mancall, E.L. and Richardson, E.P., 1958. Progressive multifocal leukoencephalopathy. Brain, 81(1), pp.93-111.
- injection, G. and Ocrevus, B. (2019). Common Side Effects of Ocrevus (Ocrelizumab Injection) Drug Center – RxList. [online] RxList. Available at: https://www.rxlist.com/ocrevus-side-effects-drug-center.htm [Accessed 17 Aug. 2019].
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