When patients are diagnosed with multiple sclerosis, then they are usually placed on immunomodulating therapy. The goal of this therapy is to prevent future attacks and future disability.

In the United States, there are five immunomodulating drugs approved for the prevention of future attacks in MS.  Three of them belong to a class of medications called beta-interferons, one is a different type of protein called Glatiramer acetate, and the fifth drug belongs to a class of medication called SAM blockers.  The trade names of the five drugs are Avonex®, Betaseron®, Copaxone®, and Rebif® and Tysabri®.  Copaxone® is glatiramer acetate and the others are all interferons.  The three interferons vary between each other in the route and/or frequency of administration and total dose.  The first four medications require injection therapy that can be performed by the patient. This fifth drug, Tysabri®, is a monthly infusion in the physicians office or similar location.  Tysabri is the newest therapy available and has its own page on this web site. Oral therapy may be available in the future.  All five have been shown to reduce the incidence of recurrent attacks in relapsing-remitting MS.  There is strong evidence to show the number of MS attacks continue to decrease the longer that any of these medications are taken.  There is some data to show that disability decreases as well but this data is less proven (it would be extremely difficult to perform the long-term placebo controlled studies needed to answer this question).  Rebif has been demonstrated to be superior than Avonex. This is not unexpected given that Rebif is a higher dose as the same molecule as Avonex. The interferons as a group are sometimes associated with antibody formation, which may limit the effectiveness of the medication, but even this is somewhat controversial.  When a patient has side effects and is unable to take one of the medications, then they should be switched to another medication, which is not likely to produce the same side effect.  There is also no clear data to guide physicians as to when to switch from one medication to another for patients who are continuing to have MS attacks. 

Patients and their physicians need to communicate with one another to determine together when to start immunotherapy and to decide which medication to begin.  The decision to switch therapy is also very subjective and again it is important for physicians and their patients to communicate.

Once immunotherapy is started, it is generally continued for life in patients who respond to the medication.  The only recommended exception in this case is the desire of a patient to become pregnant.  In this case, patients should stop the immunomodulating therapy prior to attempting to become pregnant.  The effect on the patient's long-term disability by stopping the immunomodulating drugs in order to become pregnant is not known.

For patients who continue to have frequent disabling attacks despite immunomodulating therapy or for those who begin to accumulate deficits, then stronger immunosuppressive treatment is commonly recommended. Recently, Novantrone® or mitoxantrone has been approved for the treatment of this group of patients. 

Other medications and treatments that are considered after mitoxantrone include medications such as cyclophosphamide, cyclosporin, IVIG, and procedures such as a bone marrow transplant.