How Do Oral Treatments for MS Work?
There are many oral treatments that can be used to treat multiplesclerosis, many of which work by protecting nerve cells, altering the activity of immune cells, or reducing inflammation.
Multiplesclerosis is an immune system disorder in which your immune system attacks the protective coating around nerves in your central nervous system. The brain and spine are part of the central nervous system.
DMTs can help slow the development of the condition.
The Food and Drug Administration (FDA) has approved 23 DMTs to treat relapsing forms of MS, including 10 DMTs that are taken orally as capsules or tablets.
Read on to learn more about how oral DMTs work.
You need to know about the role of immune cells in the disease to understand how oral DMTs help.
The inflammation and damage in Multiplesclerosis can be caused by many types of immune cells and molecules.
These include T cells and B cells, two types of white blood cell known as lymphocytes. They’re produced in your body’s lymphatic system.
T cells can travel to your central nervous system when they move from your lymphatic system into your bloodstream.
Certain types of T cells produce proteins known as cytokines, which trigger inflammation. In people with MS, pro-inflammatory cytokines cause damage to myelin and nerve cells.
B cells may play a role in the development of multiplesclerosis.
DMTs limit the movement of T cells, B cells, or both. This helps reduce inflammation in the central nervous system. DMTs can protect nerve cells from damage.
The FDA has approved the use of cladribine (Mavenclad) to treat relapsing forms of MS in adults. To date, no studies have been completed on the use of Mavenclad in children.
The medication enters into the cells and causes them to stop being able to repair and synthesise DNA. The number of T cells and B cells in the immune system is reduced.
You will take two courses of the drug over 2 years if you receive treatment with Mavenclad. Each course will have 2 weeks of treatment.
Your doctor will tell you to take one or two daily doses of the drug for 4 or 5 days during treatment.
The FDA has approved dimethyl fumarate (Tecfidera) for treating relapsing forms of MS in adults. The generic form of the drug has also been approved.
The FDA has not approved the treatment for children with Multiplesclerosis. Doctors can prescribe this medication to children in a practice called off-label use.
Although more research is needed, studies to date suggest that this drug is safe and effective for treating MS in children.
Experts don’t know exactly how Tecfidera works. However, researchers have found this medication may reduce the abundance of certain kinds of T cells and B cells, as well as pro-inflammatory cytokines.
Tecfidera also appears to activate a protein known as nuclear factor erythroid 2-related factor (NRF2). This triggers cellular responses that help protect nerve cells from oxidative stress.
If you are prescribed Tecfidera, your doctor will recommend you take a 120-milligram dose twice per day for the first 7 days of treatment. They will tell you to take a double dose of the drug after the first week.
The FDA has approved diroximel fumarate (Vumerity) to treat relapsing forms of MS in adults. Experts don’t yet know whether this medication is safe or effective in children.
The same class of medications is called Vumerity. It is believed to be similar to the one in Tecfidera, which is believed to have activated the NRF2. This sets off cellular responses that help protect nerve cells.
If your treatment plan includes Vumerity, your doctor will advise you to take 231 grams of the medication twice per day for the first 7 days. You should take 462 of the medication twice a day.
The FDA has approved fingolimod (Gilenya) for treating relapsing forms of MS in adults as well as children ages 10 years or older.
“The FDA hasn’t approved this medication for treating younger children, but doctors may prescribe it off-label to kids under the age of 10”
This medication blocks the signaling molecule from binding to T cells and B cells. This prevents the cells from entering the bloodstream and going to the central nervous system.
“The cells can’t causeInflammation and Damage in the CNS if they’re stopped from traveling.”
Gilenya is taken once a day. The recommended daily dose is only for people who weigh more than 40 kilograms. The recommended daily dose is 0.25 percent for those who weigh less than that.
If you stop using the medication and start treatment, you may experience a severe flare.
Some people with MS
The FDA has approved siponimod (Mayzent) for treating relapsing forms of MS in adults. So far, researchers haven’t completed any studies on the use of this medication in children.
Mayzent is a class of drugs. It blocks S1P from binding to T cells and B cells. Immune cells can cause damage if they travel to the brain and spine.
Mayzent is taken once a day. A genetic marker that can help predict your response to a medication is what a doctor will use to determine your optimum daily dosage.
If your genetic test results suggest that this medication might work well for you, your doctor will prescribe a small dose to start. They’ll gradually increase your prescribed dose in a process of known as titration. The goal is to optimize potential benefits while limiting side effects.
If you stop using the medication, your condition will get worse.
The FDA has approved the use of teriflunomide (Aubagio) for treating relapsing forms of MS in adults. No studies have been published so far on the use of this drug in children.
Aubagio blocks an activity of the dihydroorotate dehydrogenase. pyrimidine is a DNA building block that is required for DNA synthesis in T cells and B cells.
“The formation of new T cells and B cells is limited when theidase can’t access enough pyrimidine.”
If you receive treatment with Aubagio, your doctor may give you a 7- or 14-mg daily dose.
The FDA has approved monomethyl fumarate (Bafiertam) for the treatment of relapsing forms of MS in adults. It is not known whether this medication is also safe or effective for children.
Bafiertam is believed to alter the immune response and protect against damage to the brain and spine.
Bafiertam is similar to other drugs used to treat multiplesclerosis, but has a different chemical structure.
A blood test is required before starting this medication. If a doctor determines that Bafiertam may work for you, they can prescribe a starting dose of 95 and a maintenance dose of 190 for the first 7 days.
The FDA has approved the use of ponesimod (Ponvory) to treat relapsing forms of MS in adults. No studies have been conducted yet on the use of this drug in children.
Ponvory works by binding to S1P to stop white blood cells from entering the brain or spine.
The recommended maintenance dose is 20. A doctor might prescribe a lower amount initially and gradually increase it over time.
The FDA has approved ozanimod (Zeposia) for treating relapsing forms of MS in adults. Additional research is needed to determine whether it’s safe for children.
Zeposia binds to S1P receptors and helps keep white blood cells in the lymph nodes to block them from crossing into the central nervous system.
If a doctor recommends a low dose of Zeposia, you may be able to increase it slowly. The recommended maintenance dose is 0.92mg.
The FDA has approved a number of DMTs that are injected under the skin or given via IV.
- Alemtuzumab is a drug.
- glatiramer acetate (Copaxone, Glatopa)
- The interferon alpha-1a is called Rebif.
- The interferon alpha-1b is a drug.
- Novantrone is a drug called mitoxantrone.
- natalizumab (Tysabri)
- ocrelizumab (Ocrevus)
- peg Interferon is called peg Interferon.
- ofatumumab (Kesimpta)
Talk to your doctor about the medications.
Treatment with DMTs can cause side effects, which in some cases are serious.
Depending on the type of DMT you take, the potential side effects can vary.
Some common side effects are listed.
- There is a throbbing head.
- There is a lot of diarrhea.
- There is a skin rash.
- hair loss
- Slow heart rate.
- facial flushing
- The abdominal area is very tender.
DMTs are also linked to an
- It is an infectious disease.
- There are shingles.
- There are certain infections.
- progressive multifocal leukoencephalopathy, a rare type of brain infection
The risk of infections is increased because the medications alter your immune system and may reduce the number of white blood cells in your body.
DMTs can cause serious side effects, such as allergic reactions. Some DMTs can cause your blood pressure to rise. Some may cause your heart rate to slow.
If the doctor believes the benefits outweigh the risks, they will recommend a DMT.
“Living with multiplesclerosis that isn’t effectively managed carries significant risks. Talk to your doctor about the possible side effects of different DMTs.”
DMTs are not generally considered safe for pregnant or breastfeeding people.
If you have health problems that could make you more vulnerable to taking the medication, you should be screened by a doctor before you start treatment.
Before you begin treatment with a DMT, a doctor may encourage you to get certain vaccinations. You may need to wait a while after getting vaccinations before you start taking the drug.
A doctor might advise you to avoid certain products while you are receiving treatment for a DMT. Ask them if there are any drugs or other products that could affect the DMT.
A doctor should also monitor you for signs of side effects during and after treatment with a DMT. For example, they’ll likely order regular blood tests to check your blood cell count and liver enzymes.
Let the doctor know if you are having side effects.
Multiple DMTs have been approved to treat MS, including 10 types of oral therapy.
Some of the medications may be better suited to certain people.
Before you start taking a DMT, you should talk to a doctor about the risks and benefits. They can help you understand how different treatments might affect your body.