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Verywell Informed

Living Well With
Multiple Sclerosis

Tools and Tips for Feeling Better

By Colleen Doherty, a Board-Certified Physician

By Colleen Doherty, a board-certified physician

Your Therapy Options

Accepting the unpredictable nature of multiple sclerosis (MS), along with starting a new medication, can be overwhelming. This is a normal feeling, one that shows how much you care about your health and your future.

While MS disease-modifying therapies are not curative—which may feel discouraging—know that they are a step in the right direction. For some, they can significantly reduce MS progression and help to live a full, vibrant life. They also serve other purposes like:

  • Decreasing the number and intensity of relapses.

  • Decreasing the number of lesions, as seen on an MRI of a person’s brain and spinal cord.

  • Slowing down MS-related disability.

There are a handful of options approved by the U.S. Food and Drug Administration (FDA) and you and your doctor may consider various ones at different stages of your disease.

Let’s compare the handful of U.S. Food and Drug Administration (FDA)-approved options available. Remember, what works for one individual may not be right for you, so understanding the details of each option is important.

Who Are These Options For?

Before we delve into each option, note that the majority of these medications are FDA-approved for relapsing-remitting MS, as well as for people with secondary-progressive MS who continue to experience relapses. Novantrone (mitoxantrone) is the only MS disease modifying-therapy that is also approved for secondary-progressive MS. Ocrevus (ocrelizumab) is approved for both relapsing and primary progressive MS.

Considering the Side Effects

The side effects listed range from mild to severe, but the potential for any side effect likely feels intimidating. Many times there are simple solutions to preventing or reducing the milder ones, and doctors are well-versed in taking measures to prevent more serious ones. What you thought was an intolerable side effect might just be an easy fix!

Take a look at this overview and then learn more about each option so you can discuss with your doctor which might be right for you.

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1/5 Interferon Therapies

Interferon Therapies

Interferon therapies reduce relapses and lesions by altering the immune system through various mechanisms.

They are all injectables, and you or a loved one can be trained on how to prepare the skin and correctly administer the medication.

Your Options

  • Avonex (into muscle 1x/week)

  • Betaseron (under skin every other day)

  • Extavia (under skin every other day)

  • Plegridy (under skin every 14 days)

  • Rebif (under skin 3x/week)

Most Common Side Effects & Coping Tips

  • Flu-like symptoms (fatigue, fever, headache, body aches) can occur. Tylenol and NSAIDs can help, and while symptoms tend to get better with time, for some people, they can be intolerable.

  • There may be redness, swelling, or itching at the injection site. Rotating sites and pretreating with a warm compress can help. Applying a cold compress after the injection can help reduce swelling.

  • Depressive symptoms may also develop in some people. Medication or therapy can help.

2/5 Zinbryta

Zinbryta

Zinbryta (daclizumab) interferes with various cells to prevent myelin sheath damage and loss. However, it’s generally reserved for people who have had an inadequate response to two or more MS disease-modifying therapies and is only available through a restricted program due to risk of severe liver injury and immune system reactions.

Administration
Zinbryta is injected under the skin once a month.

Most Common Side Effects & Coping Tips

  • Cold and flu symptoms, including headache and sore throat, and swollen lymph nodes may occur. Tylenol and NSAIDs can help.

  • Skin rashes, like eczema and allergic dermatitis, may occur. If moderate to severe, topical or oral steroids can help.

  • Depressive symptoms may develop. Medications or therapy can help.

  • Liver enzymes may elevate. Monitoring before, throughout, and after treatment can prevent serious complications.

3/5 Glatiramer Acetate

Glatiramer Acetate

Glatiramer acetate is thought to imitate a protein in the myelin sheath, preventing attack on the real one, but the exact process is unclear.

Both are injectables and can be taken by women who are pregnant or attempting to be pregnant.

Your Options

  • Copaxone (under skin daily or 3x/week, depending on dose)

  • Glatopa (generic form, under skin daily)

Most Common Side Effects & Coping Tips

  • Redness, swelling, itching, or hard lumps can occur at the injection site. Rotating sites and applying a warm compress prior to injecting can help.

  • The skin condition lipoatrophy (loss of fatty tissue at injection site) can occur. Rotating sites and avoiding clustering injections can help.

  • In rare cases a full-body post-injection reactions of flushing, chest tightness, racing heart, and anxiety can manifest. It isn’t harmful and goes away on its own within 15 minutes.

4/5 Oral Therapies

Oral Therapies

Available oral therapies affect the immune system to prevent further damage to the myelin sheath. They come in capsules that you take daily.

Your Options

  • Gilenya (1x/day)

  • Aubagio (1x/day)

  • Tecifedra (2x/day)

Most Common Side Effects & Coping Tips

  • Gilenya can cause headache, flu, back pain, cough, abdominal or extremity pain, and sinus inflammation, all of which Tylenol or NSAIDs can help. Diarrhea may also occur, so be sure to drink plenty of water.

    Liver enzymes may rise, so monitoring is important. A drop in heart rate may occur with the first dose, so ECG monitoring is needed, and those with heart problems may not be candidates.

  • Aubagio can cause headaches, diarrhea, or a rise in liver enzymes. Antiemetics can help any nausea. Hair thinning may also occur but is generally mild to moderate and short-lived, improving on its own.

  • Tecifedra may also cause flushing, nausea, diarrhea, and abdominal pain. Taking it with food can ease GI upset.

    Very rarely, a brain infection called PML has been seen. Seek medical attention if new neurological symptoms and/or confusion or personality changes occur in order to prevent serious complications.

5/5 Infused Therapies

Infused Therapies

Infused therapies for MS work on the immune system to prevent further myelin sheath deterioration.

They are administered through a needle into the vein, thus requiring scheduled visits to a certified clinical setting.

Your Options

  • Lemtrada (daily for 5 days, then daily for 3 days one year later)

  • Novantrone (every 3 months for 2 years)

  • Tysabri (every 4 weeks)

  • Ocrevus (2x/month, then once every 6 months)

Most Common Side Effects & Coping Tips

  • With Lemtrada, premedication with steroids can calm infusion reactions (headache, rash, nausea, fever). Antiemetics can ease nausea. Tylenol or NSAIDs can help with any fatigue, nasal congestion, infection, diarrhea, flushing, and joint and back pain. Lemtrada is only reserved for people who have not responded well to two or more other therapies. Those with HIV are not eligible.

  • Novantrone can cause blue-green colored urine, nausea, mild hair thinning, loss of menstruation, UTIs, and mouth sores. Most of these are harmless and temporary, others resolve with proper care. Note: it is not commonly prescribed due to risk for acute myelogenous leukemia and cannot be used in those with a history of chemotherapy or heart and liver issues.

  • Tysabri can cause infusion-related symptoms. To decrease PML risk, close monitoring is needed. Note: Tysabri can only be administered in an approved infusion facility.

  • Ocrevus can cause infusion-related reactions. Premedication with methylprednisolone and an antihistamine (Benadryl) is required 30 minutes prior to infusion. Acetaminophen can be added as well.

    There is increased risk of infection, especially herpes and respiratory tract infections. If present, infusion is delayed. Those with hepatitis B are not eligible.

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Starting or Changing Your Therapy

When deciding on a therapy option with your neurologist, be sure to discuss all of your concerns and questions, including cost, so that you can make the best decision. Keep the line of communication open after you’ve started the therapy, too.

Know that you may need to switch therapies if one is not working or its side effects are not tolerable. This is okay, but it’s always important to consult with your doctor before deciding to stop a medication on your own. This way there are no unintended health consequences.

Symptoms You Can Manage

Every person with MS has symptoms unique to them because different nerve fibers are attacked in different people. There are multiple patterns of MS and their diversity further supports the concept that MS is an unpredictable, wholly unique illness for every individual.

And while you cannot control many aspects of your disease, you can control your lifestyle habits, which may have a positive impact on your MS symptoms and overall health.

Types of Symptoms

The variety of MS symptoms stems back to the root cause of MS: a person’s immune system attacks its own central nervous system (the brain and spinal cord).

The immune system attacks its own nervous system, leading to a variety of symptoms.

Types of Symptoms

The variety of MS symptoms stems back to the root cause of MS: a person’s immune system attacks its own central nervous system (the brain and spinal cord).

Normally, a fatty covering called the myelin sheath surrounds nerve fibers, allowing impulses to be passed quickly and effectively so that the brain and spinal cord can communicate with each other and the rest of the body.

With MS the myelin sheath is deteriorated, as pictured, impairing nerve signaling and communication and leading to neurological symptoms like sleep disturbances, fatigue, depression, cognitive problems, bladder and bowel problems, sexual problems, and pain.

Lifestyle Tips

Consider these behavioral interventions for the more common day-to-day symptoms you may be experiencing. In some cases, a medical intervention can also be helpful. In all cases, you should speak with your doctor to see what options are available.

  • Overactive Bladder

    Overactive Bladder

    • Schedule consistent visits to the bathroom

    • Limit fluid intake two hours prior to bedtime

    • Limit caffeine and alcohol intake

    • Try pelvic floor physical therapy

    • Wear an absorbent pad/condom catheter

  • Sleep Disturbances

    Sleep Disturbances

    • Limit caffeine and alcohol intake

    • Limit fluids after dinner

    • Avoid prolonged afternoon naps

    • Schedule a visit with a sleep specialist

  • Fatigue

    Fatigue

    • Keep a consistent sleep schedule

    • Avoid heat

    • Strategize chores and work tasks with occupational therapy

    • Try rehabilitation programs

    • Practice stress management techniques

  • Cognitive Problems

    Cognitive Problems

    • Carry a notebook to help remember

    • Challenge yourself with books and puzzles

    • Exercise

    • Get adequate sleep

    • Plan ahead for larger tasks

    • Forgive yourself

    • Consider cognitive rehabilitation

  • Depression

    Depression

    • Exercise regularly

    • Incorporate social interactions

    • Join an MS support group

    • Consider medication options

  • Bowel Problems

    Bowel Problems

    • Maintain a high fiber diet

    • Exercise regularly

    • Consider seeing an occupational therapist

    • Consume adequate fluid

  • Sexual Problems

    Sexual Problems

    • Consider sex therapy

    • Have sex when well rested

    • Treat fatigue

    • Treat urinary incontinence

  • Pain

    Pain

    • Exercise (e.g. stretching, swimming)

    • Applying cold or heat, but avoid overheating

    • Staying Healthy

    • Consider walking aids

Real Life Tips for Coping

It’s important to know that while you may have MS, it does not define you. Instead, it’s simply a fork in the road or a slice of your life pie.

Sometimes it helps to hear struggles and good moments from others who are experiencing a similar but unique journey. Watch the videos to learn about Michelle, who was diagnosed with MS in 2014. She shares tips for coping with the day-to-day emotions and challenges you may also be experiencing.

Now Playing

  • Getting Diagnosed

  • Being Involved

  • Working With Your Medical Team

  • Staying Healthy

  • Working With Loved Ones

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    Getting Diagnosed

  • Play Video

    Being Involved

  • Play Video

    Working With Your Medical Team

  • Play Video

    Staying Healthy

  • Play Video

    Working With Loved Ones

Resources

Outside of doctors, friends, and family, unbeknownst to many there is an extraordinary MS community out there just waiting to include and connect with more people living with MS. Social media sites, like Facebook, Twitter, Pinterest, and Google+ offer a number of MS-related support measures.

Here is just a snippet of some popular MS resources:

  • MSconnection.org is an online community hosted by the National MS Society for people living with MS, as well as their loved ones.

  • Positive Living With MS is an uplifting Facebook page where members connect, laugh, share stories, emotions, and hard times.

  • MSWorld.org is an online resource that offers summaries of MS professional conferences.

  • MyMSTeam is a social and support network. You can use it to find friends, tips, and answers to common questions.

  • MSFriends is a telephone-based program by the National MS Society where you can connect with specialized and trained volunteers.

  • Your local MS Chapter helps connect you with others who live near you and provides information on meetings, volunteering, and more.

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Real Life With Multiple Sclerosis

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