Approved Long-Term Treatments

The first three long-term MS treatments to be approved were dubbed the "A-B-C" drugs because of their brand names: Avonex®, Betaseron®, and Copaxone®. These are interferon beta-1a, interferon beta-1b, and glatiramer acetate, respectively. All were approved by the Food and Drug Administration (FDA) for treating RRMS. These drugs have been used for several years and research shows that people are doing well on these medications for long periods of time (up to 20 years to date).

The fourth drug to be approved by the FDA was Novantrone® (mitoxantrone), and this was the first drug indicated for both worsening RRMS and SPMS. News then arrived of a fifth FDA-approved drug for RRMS: Rebif® (interferon beta-1a). This is the same drug as Avonex, but is injected differently and in more frequent and higher doses.

Several large clinical trials have been conducted to study each of these drugs separately for their effects on MS. Although differences exist in study design and specific findings, trials generally showed these common results:

• Reduced the number of relapses
• Reduced the severity of relapses
• Reduced the development of new areas of inflammation as seen on MRI
• Showed some evidence of delaying short-term disease progression

Each of the approved treatments has side effects which are usually manageable. Novantrone is the only drug that has a set limit of doses, which is necessary to avoid cardiotoxicity (heart damage). The other drugs appear safe provided the person taking the drug is not experiencing any adverse effects and blood tests continue to be normal.

While no damage to the reproductive system or the fetus has been observed, these drugs are not recommended if a woman is pregnant or considering pregnancy during her treatment period. Male patients considering long-term treatment should discuss options for family planning with their doctor.

Other treatments are sometimes used to try to slow MS disease progression when other therapies have been ineffective. Such treatments are approved by the FDA for other illnesses, but not specifically for the treatment of MS. These include intravenous immunoglobulin (IVIg) therapy, methotrexate, azathioprine (Imuran®), and cyclophosphamide (Cytoxan®).

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