Injectable medications for multiple sclerosis (MS) are known as disease-modifying therapies (DMTs). This means they work by slowing or changing the progression of the condition.
The oldest injectable medications are interferons:
- interferon beta-1a (Avonex, Rebif)
- interferon beta 1b (Betaseron, Extavia)
- pegylated interferon beta-1a (Plegridy)
These are self-administered directly into the muscle (intramuscular) or underneath the skin (subcutaneous). Depending on the medication, they are given every other day to once every 14 days.
Glatiramer acetate (Copaxone) is considered part of the “platform therapy” for MS. It’s also among the earliest approved disease-modifying treatments. It’s self-administered as a subcutaneous injection, either daily or three times a week.
The newest DMTs are monoclonal antibodies. These treatments target specific molecules within the immune system that play a role in MS.
Common monoclonal antibodies for MS include:
- natalizumab (Tyruko, Tysabri)
- ocrelizumab (Ocrevus)
- rituximab (Rituxan)
- ofatumumab (Kesimpta)
- alemtuzumab (Lemtrada)
- ublituximab (Briumvi)
Only ofatumumab may be self-administered as a subcutaneous injection once a month (after 3 initial weekly doses). The others are administered directly into the vein (intravenously) by a healthcare professional.
The different delivery methods available for MS medications allow you and your doctor to determine which option will work best for you based on effectiveness, side effects, and convenience.
Injectables are generally considered the safest method. However, they may not work as well, so a
People who value convenience may prefer oral therapies, which you take one to two times a day. Common side effects include:
- gastrointestinal issues, such as diarrhea, nausea, or abdominal pain
- liver enzyme elevations
- low white blood cell counts
- increased risk of infections
Infusion treatments are considered the most effective of the DMTs and may be the preference for those with highly active and aggressive MS. However, infusion therapies are also associated with a risk of serious infections.
Depending on which injection a doctor prescribes, the frequency can vary from daily (glatiramer acetate) to once a month (ofatumumab).
For interferons, the most common side effects include:
- injection site reactions such as swelling
- flu-like symptoms
- liver enzyme elevations
Glatiramer acetate may also cause injection site reactions and lipoatrophy (loss of fat tissue in the areas of injection) over time.
How long you have to take an injectable varies from person to person and depends on the severity of your symptoms.
In general, people with MS can continue taking an injectable for many years, with the potential for lifelong therapy. However, some people switch from injectables to other forms of treatment.
If their MS has been under management, other people are able to stop injectables altogether after long-term use.
Dr. Susan W. Lee is an ABMS board certified neurologist with fellowship training in clinical neurophysiology. She currently practices in Los Angeles, and her subspecialty interests include the management of epilepsy and headache disorders.