Treating Multiple Sclerosis
Multiple sclerosis (MS) is an autoimmune disease in which the body's immune system attacks what is called the myelin sheath that covers the nerves in the brain and spinal cord. Myelin surrounds the nerve fibers to protect them. When the myelin is damaged, the messages that travel along the nerve or nerves may be slowed or blocked, resulting in a delayed response to external stimuli.
MS is a relatively rare disease, the exact cause is unknown. MS is most commonly diagnosed in people between the ages of 20 and 40, most often in women. The clinical picture of MS is extremely variable, between and among individuals, in terms of symptoms, progression and treatment response. Symptoms vary between from mild to severe, may be ongoing or intermittent, may be tolerable for some patients, disabling for others, and may be treatable or non-treatable.
Autoimmune Process
Possible Symptoms of MS
- Hyperesthesia (increased sensitivity to pain)
- Paresthesias (“pins and needles”)
- Visual disturbances, diplopia (double vision); nystagmus (rapid, jerky rhythmic eye movement)
- Dysequilibrium, unsteadiness
- Muscle weakness or spasticity
- Tremors
- Difficulty swallowing
- An inability to adequately empty the bladder
- Nausea, vomiting, abdominal fullness or bloating, diarrhea or constipation
- Low blood pressure with dizziness
- Trouble maintaining an erection
When the body mistakes its own tissue as "the enemy" or as “foreign”, antibodies form against self. In the case of MS, that “self” is the protective myelin sheath of the nerves in the brain and spinal cord. During inflammation, the myelin gets stripped from the axons (demyelination).
As the myelin around the nerves is damaged, the ability of the nerves to conduct electricity lessens. Depending on which nerve fibers are damaged, patients can experience problems ranging from weakness and clumsiness to numbness, tingling, problems with vision and even emotional and intellectual changes. Since the areas of damage are variable, the disease itself is unpredictable. Symptoms depend on the site and degree of damage.
Presenting symptoms of MS often cycle, with signs of active disease alternating with remission that can last for weeks, months or years. Typically, though, the disease gradually progresses, with remissions and exacerbations that eventually produce some disability.
Therapy Support & Medications
The goals of therapy are to return the patient to function after an attack, prevent new attacks and prevent or minimize disability. There are several different types of medications that can be used. Some patients may start on steroids, but ultimately need what we call disease-modifying therapy. These drugs include:
- Interferons which help the communication between the interferons do have significant side effects for most patients. Most often, patients feel like they have a really severe flu. Some patients will not be able to tolerate these symptoms and have to stop this therapy.
- Glatiramer acetate (Copaxone®) seems to work as a decoy for the immune system and the immune system attacks the drug instead of the myelin. Side effects may include a dent at the injection site. This is called lipoatrophy or lypodystrophy.
- Mitoxantrone may be given but can lead to heart damage so must be given carefully and usually for a short time only.
- Natalizumab (Tysabri®) is effective and well tolerated by most patients. There have been rare cases of a rare brain disease, progressive multifocal leukoencephalopathy (PML), so patients who take Tysabri are monitored closely.
- In June 2010 the FDA approved the first oral medication, fingolimod (Gilenya®), for MS. While generally well-tolerated, patients should be monitored for liver dysfunction, macular edema (swelling of the central portion of the retina, causing distorted vision), elevated blood pressure, shortness of breath, bronchitis and diarrhea.
Most frequently prescribed medications for managing MS include*:
Your Partner in Therapeutic Success
CoramRx maximizes compliance, minimizes complications and helps patients achieve therapeutic success in the most cost-efficient and clinically effective way possible. One week prior to each prescription dispense, you will receive a refill reminder phone call. To help ensure success with your MS therapy, your pharmacy department team member will ask a series of clinical monitoring questions related to: compliance to prescribed therapy, drug side effects, hospitalization, change in medication profile, disease status and effectiveness of prescribed therapy.
Patient Resources
The organizations listed below offer a variety of services and resources for consumers and caregivers. Please note that some organizations may charge a fee for access to services. This listing is not an endorsement of these organizations, or information they may disseminate. We strongly suggest you discuss any information you receive from these organizations with a qualified professional before making any changes in your healthcare, insurance coverage or home care provider.
Multiple Sclerosis Caregivers — provides helpful information for MS cargivers including links to MS-focused blogs, articles, community links and research.
Multiple Sclerosis Foundation provides a comprehensive approach to helping people with MS maintain their health and well-being through support, education and promoting awareness.
National MS Society — helps people affected by MS by funding cutting-edge research, driving change through advocacy, facilitating professional education, and providing programs and services that help people face the challenges of living with MS.
U.S. News Health Mulitple Sclerosis — article provides an overview of MS, symptoms, testing and treatment as well as how to manage your condition.
FDA: Disposing Unused Medication — government guidelines for disposing unused medicine. The Food and Drug Administration (FDA) worked with the White House Office of National Drug Control Policy (ONDCP) to develop the first consumer guidance for proper disposal of prescription drugs.
Learn More
- To learn more about your options for managing Multiple Sclerosis and CoramRx, please contact us.
- To enroll as a Multiple Sclerosis patient with CoramRx, please complete our Patient Enrollment Form.
*Please contact CoramRx about other therapies not listed here.