Options for Worsening Disease

Change Medications

Monoclonal antibody therapies provide significant power in tackling worsening relapsing multiple sclerosis.  Tysabri dropped relapses by a robust 68% compared to placebo. With over a decade of experience, Tysabri is an excellent option for the patients with a negative blood test for the JC virus.  Positive JC virus test increases risk of a brain viral infection called PML. Ocrevus, given once every 6 months, has also be shown to reduce relapses by 46-47% and reduced disability by 40% compared to Rebif.  Kesimpta injected under the skin every 4 weeks reduced relapses 51-58% and  disability progression 34-35% compared to the oral medication Aubagio.  Lemtrada reduced relapses by 49-55% compared to Rebif and reduced disability progression by 42% compared to Rebif in those patients previous treated with other MS medications.  Lemtrada is given through an infusion over 5 days the 1st year, then 3 days the 2nd year and then only as needed treatment.

Mayzent slowed down disability progression in a trial of 1651 multiple sclerosis patients with secondary-progressive multiple sclerosis.  Patients on Mayzent had a 21% less risk of disability progression than those patients on placebo with up to 3 years of monitoring. Ocrevus is the only MS medication approved for primary progressive disease.  In a primary progressive trial (ORATORIO) of 732 patients, treatment with Ocrevus reduced risk of disability progression by 24% compared to placebo treatment.

Multiple oral medications can reduce relapses by greater the 50%.  For example, 4-5 days of oral Mavenclad given over 4 cycles in 2 years reduced relapses by 58% compared to placebo. 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.

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.  Clinical trials in relapsing multiple sclerosis generally randomly assign patients to an experimental therapy or a FDA-approved medication treatment.  You will be informed prior to enrolling in a trial if some people will be on a placebo (no treatment) group . The unknown and known risks of an experimental medication must be carefully considered before enrolling in a clinical trial.