Disease Modifying Therapies
Disease-modifying therapies (DMT's) can affect the course of MS. Although not a cure, disease-modifying therapies act to reduce the number and severity of MS relapses. They also reduce the number of new MS lesions. It is not yet known whether these drugs will slow down the rate of disability in the long-term.
Information on all the DMTs that are currently available in Ireland can be found in this table, including administration methods, possible side effects and how the medication is paid for. More detailed information on each medication is available in the information sheets below.
Changing the course of the disease
Disease-modifying therapies (DMT) act to reduce the number and severity of MS relapses and slow down the rate of progression of the condition. They are not a cure and may not be suitable for everyone. However, they are a standard treatment for relapsing-remitting MS.
There are a number of different DMTs available in Ireland. DMTs can be categorised as either first-line or second-line treatments. First-line treatments are prescribed to those with relapsing-remitting MS who have experienced one or more relapses. People with secondary progressive MS who are still experiencing relapses can also be prescribed first-line therapies. Second-line therapies are prescribed in people with very active MS from the outset or in people who have failed treatment with first-line drugs.
DMTs are administered differently, some are self-injected once to several times per week, some are oral tablets, some by monthly infusion and some are administered in two or more treatment cycles. The efficacy and safety of these drugs has been established through a series of clinical trials and they have all met the required regulatory requirements for use in Ireland.
How do disease modifying therapies work?
Different DMTs work in different ways and each is associated with a particular set of benefits and possible side effects. The drugs currently available interact with different parts of the immune system to calm down the inflammation that causes MS.
Choosing a DMT
Choosing the right therapy can make a big difference in successfully managing your MS. Be sure to read all the information available to you in order to make an informed decision. Once you have read about all the therapies available to you, it is important to discuss the following considerations with your doctor. Consider the following:
• What are the known side effects that I should expect?
• How well can I tolerate the side effects?
• How effective is the therapy?
• How can I introduce it into my lifestyle?
Deciding when to start using a DMT
Recent research now strongly suggests that long-term outcomes for people with relapsing forms of MS are improved by starting treatment with an appropriate DMT as soon as possible after diagnosis. Many neurologists therefore now advise people with MS to start treatment early, even if their symptoms are mild.
Choosing not to use a DMT
Some people with MS decide not to use a DMT even if their neurologist believes it would suit their MS. Often people wish to manage their MS by changing their lifestyle or by using alternative therapies and remedies. Some people do not wish to take drugs at all or want to wait until they feel they need them. If you decide not to start treatment with a DMT or discontinue treatment, make sure you have discussed this fully with your healthcare professionals and ensure that there is a monitoring plan in place.
Avonex is the brand name for a disease modifying treatment for people with MS. The active ingredient is interferon beta 1a, which comes in a solution or powder, and is given by injection.
Betaferon (interferon beta-1b) is a type of medicine known as an interferon, which is used to treat MS. Interferons are proteins found naturally in the body, which may help boost the immune system and fight infections.
Brabio is the brand name for Glatiramer Acetate injection. Brabio is a synthetic combination of four amino acids, resembling the myelin protein which surrounds nerve fibres. It is thought to reduce the immune response that attacks myelin. Brabio is a disease modifying therapy available to people living with relapsing-remitting MS.
Copaxone is the brand name for glatiramer acetate injection. Copaxone is a mixture of four amino acids, the natural building blocks of proteins in the body. Copaxone is the first non-steroidal, non-interferon MS drug therapy available to people living with relapsing-remitting MS.
Fampyra is a slow-release oral tablet for the symptomatic treatment of walking impairment in adults with multiple sclerosis.
Gilenya (Fingolimod) is a new type of therapy that can be taken orally rather than by injection or infusion. It is known as a disease modifying therapy (DMT) and targets the immune system to reduce relapses.
Lemtrada (alemtuzumab) is an experimental drug treatment (an annual infusion) that is currently being tested in clinical trials for people with relapsing remitting MS. The new marketing name for Alemtuzumab is Lemtrada.
Rebif belongs to a class of medicines known as interferons. These are natural substances that transmit messages between cells. Rebif is a highly purified soluble protein, which is similar to the natural interferon beta that is produced in the human body. It has been shown to reduce the number and the severity of relapses and to slow the progression of disability in patients with MS
Tysabri is given to patients with highly active forms of relapsing-remitting MS or those who have failed on other disease-modifying therapies. ‘Highly active’ is defined as two or more disabling relapses in a year and the presence of more lesions on the brain in an MRI scan.
On 7th March 2018, the European Medicines Agency withdraw their license for Zinbryta due to reports of serious adverse events.
Mavenclad is a disease modifying drug for adults with highly active relapsing MS. It is a short course oral therapy that you take as a tablet in two treatment courses, twelve months apart. Following completion of the 2 treatment courses, no further cladribine treatment is required in years 3 and 4