Other Treatments Used for MS Disease Progression

(These treatments are not FDA approved specifically for use in MS)

Intravenous immunoglobulin (IVIg) therapy uses pooled human immunoglobulin, which is an antibody derived from the blood of healthy donors. IVIg therapy is believed to regulate the immune system through different mechanisms, and may hold back inflammation by suppressing the production of pro-inflammatory cytokines, while possibly increasing the opportunity for remyelination.

Most of the studies with IVIg have been small, poorly designed, and have provided incomplete data. For these reasons, the effectiveness of this therapy has yet to be determined. Most study results suggest that IVIg therapy reduces the relapse rate but not the relapse severity, and may slightly improve EDSS scores or promote remyelination. MRI results are varied, and at least one study showed no improvement in the total lesion score.

Low-dose IVIg treatment appears to be well tolerated, with severe side effects such as aseptic meningitis, renal failure, vascular events, viral infection, exzema, and anaphylaxis occurring rarely. The optimal dose and frequency has yet to be determined, and combined with the lack of study data, as well as the variations in IVIg preparations, this therapy is not a first choice of treatment by most physicians. Methotrexate is an immunosuppressive drug that inhibits DNA synthesis and cell division. This is normally administered in weekly oral doses to people with progressive types of MS. Methotrexate's effectiveness appears to be minimal, but may reduce deterioration. In one study, individuals taking methotrexate experienced less decline in upper limb function -- although in many instances the individual's MS was advanced, and lower limb function was already too severe to observe any changes.
Methotrexate frequently produces gastrointestinal problems as well as mucosal irritation. Liver function may also be affected.

About 20 percent of people taking this drug may develop chemical hepatitis. Azathioprine (Imuran®) is thought to suppress the immune system by changing the metabolism of protein in certain cells. This drug appears to reduce the number of exacerbations along with a modest slowing of disease progression.

Since the approval of the "A-B-C" drugs, Imuran®'s role in MS has been diminished. Currently, this drug is sometimes added to one of the A-B-C drugs in an attempt to enhance a less-than-optimal response to the latter. Many of these people, however, are now given Novantrone® instead. Imuran® may also be used to treat progressive MS, although its success in this area is unproven.
In addition to the uses mentioned, Imuran® may be helpful in another way. Sometimes individuals with MS may experience a worsening of their symptoms after discontinuing high-dose steroid treatment. Imuran® may help to wean patients off the steroids.
Imuran® carries with it both side effects and some serious risks, so careful monitoring of patients is necessary on an ongoing basis. Approximately one tenth of those with MS are unable to take this drug because of its side effects. These often relate to stomach and eating disorders, such as pain in the abdomen, nausea, and anorexia. While the risk of cancer is mildly increased, other risks - such as skin problems, infection, depression of bone marrow and changes in liver function - may occur.

Cyclophosphamide (Cytoxan®) affects the metabolism of white blood cells, destroying lymphocytes and causing immunosuppression. Administered intravenously on either a monthly or bimonthly basis, cyclophosphamide is used to treat individuals with progressive forms of MS. This drug causes a substantial reduction in the number of T-helper cells along with lessening the decrease of T-suppressor cells.
In clinical trials, results have been mixed. Cyclophosphamide therapy in conjunction with corticotropin resulted in 80 percent of those treated being either stabilized or improved in terms of disability after one year. Another study of cyclophosphamide alone seemed to produce no effect during the first year, but enabled some people to remain stable or even improve at two and three years, provided bimonthly boosters were continued.

Individuals with progressive forms of MS who are under 40 years of age are more likely to respond to this treatment than those over 40. High-dose, short-term side effects include an increased chance of infection, nausea, hair loss, and possible damage to the bladder. Long-term use may affect the reproductive system - potentially causing sterility or mutations - along with a greater chance of cancer.