Options for Worsening Disease
Switching between classes of medications such as Interferons and Copaxone might be helpful, but both classes of medications lowered relapses by about one third. Since randomized head-to-head trials showed some benefit of Rebif and Betaseron over Avonex on relapses and MRI activity, switching from Avonex to Betaseron or Rebif might be useful. Aubagio was also shown to reduce relapse by 31 to 36% vs. placebo in two trials.
Gilenya, Tecfidera and Tysabri are definite options for worsening relapsing disease, but carry increased risks. Gilenya reduced relapses by 48-54% in two clinical trials compared to placebo and reduced relapses by 52% compared to Avonex. Tecfidera lowered relapses by 44-53% compared to placebo. Tysabri dropped relapses by a robust 68% compared to placebo. Tysabri is an excellent option for the patients without exposure to the JC virus. A negative blood test for the JC virus makes the risk of a brain viral (PML) infection rare.
Enter a Clinical Trial
When running out of treatment options due to worsening disease or tolerability problems with current medications, a clinical trial may be an option. Some clinical trials allow access to promising new medications that are still being studied and not FDA-approved. If your disease is worsening, enrollment in trial with a chance you could be on no treatment (placebo) would most likely be not advisable unless you have no other options. Some trials allow all patients to be on medication. The unknown and known risks of an experimental medication must be carefully considered before enrolling in a clinical trial.