Multiple Sclerosis Treatment: Disease-Modifying Therapies and Their Role

Let's Know About Multiple Sclerosis

We all know that nerves are like connecting dots in our body. They help to maintain our connection with the outside world. Even without nerves, we will not be able to do anything or give any response. That is why any damage to the nerve can have a dangerous effect on our body, mind, and lifestyle. One of the most common reasons for nerve damage, apart from injury, is multiple sclerosis. This is one of the main reasons behind nerve-related diseases and complications. Over 2.8 million people on this planet suffer from this chronic disease. As the body turns into its own enemy in this disease, it starts destroying the nerve covering over a period of time. Slowly, you can experience nerve damage-related issues like eye problems, vision issues, unusual sensations in the body, problems in daily activities, and fatigue. Needless to say, if you do not take proper treatment, your condition will worsen.

Understanding Disease-Modifying Therapy in MS?

In multiple sclerosis, the body destroys itself. Defense cells in the body, like T-lymphocytes, damage the nerves, which makes it difficult for doctors to cure. That's why the doctors try to pause or slow the progression of the disease. This can give the patient a better life. Also, patients can live a relatively normal life for a longer duration. This type of treatment is known as disease-modifying therapy.

Multiple sclerosis can cause issues throughout your life. Moreover, symptoms of this condition worsen in the long run. Also, there are chances that even if you are undergoing the right treatment or following the right lifestyle, you might experience relapses. This is a disease-modifying therapy (DMT). It is important in multiple sclerosis. Long-term multiple sclerosis (MS) treatment with DMT can prevent relapses and progression of the disease.

If you want to know how DMTs work in MS, you have to go deep into multiple sclerosis.

The immune system of your body attacks the protective layer of nerves and destroys it. As a result of it, the outermost layer of your brain and spinal cord is damaged. Apart from this, nerve bodies present in your brain are also damaged.

Disease-modifying therapy can lower the immune response of the body and can reduce the inflammation. Due to this, there is less nerve damage and fewer lesions in the brain and spinal cord.

Which Disease-Modifying Therapies Are Approved by the FDA for MS?

So far, the FDA (Food and Drug Administration) has approved a few medicines as disease-modifying therapy in multiple sclerosis. These are

1. Interferon-beta: This is one of the earliest medicines that can be used in disease-modifying therapy. This naturally present amino acid can prevent lymphocytes from crossing the blood-brain barrier and prevent unnecessary damage. Also, this produces an antibody that neutralizes the unnecessary immune response of the body. Apart from this, it contains various substances that lower the inflammatory response of your body.

2. Glatiramer Acetate: This is the second approved medicine for multiple sclerosis. This is made up of artificially produced polypeptides or amino acids. This can lower the activity of T-lymphocytes in the body and can lower the amount of inflammatory chemicals in our central nervous system.

3. Teriflunomide: This is a new drug for multiple sclerosis and is popularly known as Aubagio. This drug can affect our immune response. Though it is still not clear how this medicine controls your MS symptoms, some doctors believe that it lowers the number of lymphocytes.

4. Dimethyl Fumarate: This medicine is popularly known as Tecfidera. This reduces the production of harmful oxygen molecules in our body and lowers the oxidative stress. As a result, the inflammatory response in our body is lowered.

5. Fingolimod: This medicine acts on the cellular receptor level and stops the autoactivation of lymphocytes by our immune system in multiple sclerosis.

6. Natalizumab: This popular disease-modifying drug is known as Tysabri. This is a humanized monoclonal antibody, which is a laboratory-produced protein acting like an antibody in our body and targeting specific harmful substances inside our body. This drug does not let the lymphocyte bind to the nerve tissues. As a result, this protects our nerves from unnecessary damage.

7. Alemtuzumab: This is also a monoclonal antibody. This medicine reduces the function of harmful cells (memory cells) that can enter our central nervous system and unnecessarily damage our nerves. Also, it can reduce the repopulation of harmful T-lymphocytes in our body.

Apart from this, the FDA recently approved several other drugs like Cladribine, Laquinimod, and Siponimod for MS treatment.

What Are the Types of Disease-Modifying Therapies in MS?

Medicines in disease-modifying therapy for multiple sclerosis can be divided based on how they are taken. Based on that, these medicines are;

1. Oral DMTs: There are certain medicines that you can consume as pills. These are medicines like Dimethyl fumarate, Fingolimod, and Teriflunomide.

2. Injected DMTs: You can take these drugs in an injection form. However, you can take these injections yourself at home. Interferon beta and Glatiramer Acetate are disease-modifying therapies that can be taken through injection.

3. Infused DMTs: You can not take these medicines by yourself. You have to take these drugs intravenously in a hospital setting or be given them by a trained healthcare provider. Medicines like Alemtuzumab and Natalizumab are given by the intravenous route.

When to Consider Disease-Modifying Therapies in MS?

Disease-modifying therapy can reduce the early problems associated with MS and prevent subclinical progression of multiple sclerosis. Also, doctors should keep in mind that, to prevent overtreatment, it's crucial to initiate a DMT for MS patients who are most likely to respond well to therapy. This decision should be based on various factors, such as the effectiveness and safety profile of the medications and the progression and activity of the disease. However, in certain cases, it is very effective. These are

1. If the patient is suffering from a relapsing form of multiple sclerosis. In such cases, patients experience a worsening of their condition every year.

2. Some patients suffer from a really aggressive form of multiple sclerosis. In such cases, it is required.

3. If the patient is having active secondary progressive multiple sclerosis (SPMS), gradual worsening of symptoms is normal with episodes of relapses. Doctors prefer DMTs in such cases, too.

MS treatment options with DMT drugs always start with the first line of medicines, which include Interferon-beta, Glatiramer acetate, Teriflunomide, and Dimethyl fumarate. However, over a period of time, patients often show poor response to these medicines. In such cases, you can shift to the second line of drugs like Fingolimod, Natalizumab, and Alemtuzumab.

What Are Risks And Side Effects Associated With Disease-Modifying Therapies?

The side effects you might experience while taking disease-modifying therapy are

1. The most common side effect you may see is flu-like symptoms associated with body and muscle pain.

2. Sometimes you may feel facial flushing with breathing issues.

3. Psychologically, patients might feel anxiety and depression.

4. Certain medicines like Teriflunomide may cause upper respiratory tract infection or chest infection.

5. Problems like hair thinning or diarrhea are also common.

6. Urinary tract infection is also common during such therapy.

7. Another common side effect is a reduction in the number of white blood cells in your body.

Also, if you are pregnant or suffer from severe cardiovascular disease, you should immediately tell your doctor before starting DMTs. Also, DMT can negatively impact the liver; you, the patient, are suffering from autoimmune hepatitis.

Conclusion:

Multiple sclerosis impacts our lives badly. You will gradually lose your ability to do things. Disease-modifying therapy can really help to keep your issues in check in such cases. However, you must understand that the disease's nature will change over time. Because of this, the doctor will modify the treatment protocol. As a patient, you must live a healthy life to fight this evil.

Key Takeaway From iCliniq:

Living with multiple sclerosis isn’t easy, it’s a journey full of unexpected turns. You have to always adapt yourself to the ever-changing nature of this disease. And perhaps just as important, staying in touch with your healthcare team and sharing any changes you notice can make a real difference in how well your treatment works. You are not alone in this, and every step you take matters.