Infusion Therapy in Multiple Sclerosis: An Emerging Therapy

What Is Infusion Therapy for MS?

Infusion therapy involves administering different disease-modifying drugs into the systemic circulation via the intravenous route. Immunoglobulin is the most commonly used MS infusion drug. It is a pooled antibody used as a biological agent.

How Does Infusion Therapy Work?

Infusion therapy is a treatment in which medication is delivered directly into the bloodstream through an intravenous route. The drug is injected into the vein using a catheter (central line - central venous catheter). A central line is a more effective form of catheter, as it is longer than a typical IV (intravenous) catheter. A major vein near the heart is mainly preferred. This type of catheter is typically used in cases that require multiple IV treatments. The advantage of infusion therapy medication is its efficacy. Oral medicine loses its effectiveness when it is processed through the digestive system.

How Are Infusion Treatments for MS Given?

Infusion therapy is administered through a needle or a catheter. The dosage is administered over a period of time. Infusion therapy acts as a disease modifier in MS. It can slow down the disease's progression and reduce its frequency of occurrence. The physician will determine the dosage and frequency of this medication. This is decided based on the severity of the symptoms. MS infusion is a specialized treatment; hence, a multidisciplinary approach is undertaken.

What Is the Need for Infusion Therapy?

Infusion therapy for MS is one of the emerging types of treatment. This is helpful in faster recovery and prevents relapse. Also, it can help prevent disability associated with multiple sclerosis.

What Medications Are Used in MS Infusion Therapy?

MS infusion medications include:

1. Alemtuzumab:

This monoclonal antibody binds to CD52, a glycoprotein expressed on the surface of various inflammatory cells, including lymphocytes and monocytes. Binding to this antigen destroys the immune cells. This is responsible for the autoimmune destruction of the immune cells. An intravenous infusion (IV) of 12 to 24 milligrams of this medication is administered over five days. After applying the initial dose, the second dose will be given in the twelfth month. At this phase, 12 to 24 milligrams of the drug are given for three days. This drug helps prevent relapse in up to 74 percent of cases. The main adverse events associated with this are rash, headache, fever, and urinary tract infection. According to some researchers, it is associated with increased cancer risk and organ toxicity. It is also associated with thyroid disorders, platelet disorders, and Goodpasture’s syndrome (a disorder of the lungs and kidneys).

2. Natalizumab:

As previously discussed, the adhesion of immune cells to endothelial cells (cells lining the blood vessels) in the central nervous system is crucial for the inflammatory response in multiple sclerosis. This process is mediated by the adhesion of inflammatory cells and is facilitated by the action of cell-like molecules, such as vascular cell adhesion molecule 1 (VCAM-1). This molecule is responsible for crossing the blood-brain barrier (BBB). Natalizumab is a monoclonal antibody that prevents the binding of the endothelial cells. This drug blocks the functioning of the VCAM-1 molecule.

Additionally, this drug prevents the activation and migration of the lymphocytes. 300 milligrams of this drug is given intravenously for 28 days. Sometimes, it is combined with interferon therapy. This combination therapy helps prevent disease progression, relapse, and disability progression. The side effects of this drug are progressive multifocal leukoencephalopathy (viral infection of the white matter of the brain), urinary tract infection, pneumonia, and skin rashes.

3. Mitoxantrone:

This is one of the most commonly used FDA (Food and Drug Administration)-approved drugs as an infusion medication for multiple sclerosis. At first, it was developed as an anti-cancer drug for leukemia and prostate cancer. It acts as an immunosuppressive agent and can be helpful in treating secondary progressive multiple sclerosis and relapsing-remitting multiple sclerosis (a type of multiple sclerosis where symptoms get worse). This drug is administered as 12 milligrams per square meter of body surface area for over 30 minutes every three months. The cumulative dose must not cross 140 milligrams per square meter of body surface area. The common side effects associated with this drug are loss of hair, infection, vomiting, and nausea.

What Are the Side Effects of Infusion Therapy?

MS infusion side effects include:

• Allergic reactions include redness, itching, rash, fever, and hives.

• Localized pain at the injection site.

• Fatigue, fever, and body aches.

• Breathing difficulties.

• Changes in the blood pressure.

What Are the Other Treatment Options for MS?

The traditional treatment option for multiple sclerosis is known as disease-modifying therapy (DMT). The goal of this therapy is to reduce the inflammatory response. The drugs used for this purpose are Interferon beta, Glatiramer acetate, and fingolimod. Interferon beta is a type of protein used to boost the immunity of the human body. It is given as a subcutaneous or intravenous injection. Glatiramer acetate is composed of a large number of peptides and is given subcutaneously. Fingolimod is a sphingosine-1 phosphate (S1P) receptor modulator and acts as an oral drug. This drug has neuroprotective effects.

Conclusion:

Any treatment for multiple sclerosis aims to reduce the amount of inflammation present in the central nervous system. Traditional treatment options cannot prevent relapse of the disease, and the onset of action of these drugs is slower. Infusion therapy for MS is an emerging therapy that prevents the relapse of this condition. However, side effects associated with these drugs are severe.

Key Takeaways:

• Infusion therapy is an advanced medication delivery system that helps increase the efficacy of the drug.

• Most people tolerate it well, apart from some allergic reactions and pain.

If you or your loved ones need consultation on infusion therapy, consult our neurologist at iCliniq.