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 Zinbryta 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. Zinbryta reduced relapses by 45% compared to Avonex.
Antibody I.V. infusions provide significant power in tackling worsening multiple sclerosis. Tysabri dropped relapses by a robust 68% compared to placebo. With over 10 years 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. 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. Ocrevus, given once every 6 months, has also be shown to reduce relapses by 46-47% and reduced disability by 40% compared to Rebif. Ocrevus is the first treatment approved for both primary progressive and relapsing forms of MS.
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 a medication treatment. Make sure you are informed if placebo (no treatment) group is part of the study. The unknown and known risks of an experimental medication must be carefully considered before enrolling in a clinical trial.