Treatment
Medical Treatments for Multiple Sclerosis
Medical treatment options for MS fall into three main categories:
- Treatment for the underlying course of the disease.
- Treatment of the more progressive forms of MS.
- Treatment of relapses/exacerbations.
Treatment for the underlying course of MS is discussed below. Treatment for more progressive disease and relapses/exacerbations appears on other pages of this website (see the menu on the left).
A Pathway Through MS: Understanding and Treating your MS
This is a video programme that has been produced to help people with MS understand their condition and the treatments available. Separate parts of this programme appear on other pages of this website.
The part of the video on this page investigates the different types of disease-modifying treatments (DMTs) that are available for MS. The video features interviews with specialists, giving up-to-date information on current treatments, as well as interviews with people with MS who describe their experience of being on a DMT.
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Points covered in this part of the video:
- Two types of DMTs are available for patients with MS: interferon beta and glatiramer acetate.
- DMTs regulate the immune system.
- All DMTs can reduce the relapse rate.
- Interferon beta treatments can slow the progression of physical disability.
- Injection type and frequency varies between treatments.
- Treatment with a DMT should be considered a long-term commitment.
Interferons
Interferons are proteins that help control (regulate) the immune system. They are naturally released by the body when inflammation occurs. One class of interferons, known as the beta interferons, has been shown to be effective in slowing down inflammation in MS, thus modifying the course of the disease - at least in the short term (refT1).
There are two types of beta interferons available to treat MS: interferon beta-1a and interferon beta-1b. These agents help regulate, or modulate, the abnormal immune response seen in people with MS. Consequently, they are known as immunomodulatory agents or disease-modifying treatments (DMTs).
Currently, the evidence from randomised controlled trials is that interferon therapy for 2 years may alter long-term outcome in multiple sclerosis (refT2).
Randomised controlled trials in multiple sclerosis often compare two or more agents - an active treatment such as an interferon beta and a 'control’ agent. In some clinical trials the comparison is made with a placebo, while in others two or more active treatments are compared. Interferon beta-1a/b agents have been shown to reduce relapses and disease progression over 2 years (refT1). When trials such as these show that treatments are effective, it is unethical to ask individuals with MS to continue taking a placebo, or an inferior treatment, for a longer period. People with MS should be allowed to benefit from a treatment that may significantly improve their quality of life.
At present, the following conclusions have been made. Therapy with interferon beta-1a/b may reduce the frequency and severity of relapses in people with relapsing-remitting MS (RR-MS) and may influence the duration of relapse. Progression of disability may also be delayed by interferon beta-1a therapy, although the effects of treatment on long-term disability cannot be reliably predicted (refT1).
Role of Neutralising Antibodies
Antibodies are molecules that the body can make as part of its normal defence (the immune system) against foreign bodies, such as viruses. For example, when a person is infected with the 'flu', their body makes antibodies against the flu virus (this takes a few days) and eventually these antibodies help to defeat the virus.
When a person gets vaccinated against flu, the doctor is injecting an inactive form of the flu virus. The person’s body will then make antibodies against the injected virus and, when they are exposed to the natural or 'live' flu, they will already have an antibody defence established. That means they can defeat the virus before it makes them ill.
When people are treated with a protein such as interferon beta, the immune system may respond by generating antibodies. Some of these antibodies may interact with the protein to prevent it from having its normal effect. These are called neutralising antibodies. Therefore, people with MS receiving interferon beta therapy may develop neutralising antibodies.
These neutralising antibodies may interfere with the beneficial effects of treatment on relapses. The effects of neutralising antibodies on disability progression are not known at present.
It appears that neutralising antibodies occur to different degrees with different interferon
beta drugs. What the clinical consequences of this may be is not yet fully understood.