Treatment for multiple sclerosis (MS) can be complex, involving a range of options, including U.S. Food and Drug Administration (FDA)-approved disease-modifying therapies (DMTs), drugs under clinical investigation, and off-label medications to manage symptoms. If you or a loved one is navigating MS, gaining a clear understanding of these different treatment paths can help support better decisions and conversations with your healthcare team.

Let’s explore how to make sense of these different drug types and treatment options.

Disease-Modifying Treatments for Multiple Sclerosis

Disease-modifying treatments are the cornerstone of MS treatment, as they’re effective in reducing disease activity and may help slow progression. Approved by the FDA for various forms of MS, DMTs work to reduce relapses, periods of new or worsening symptoms, and the development of new lesions. Relapses are also sometimes called exacerbations or clinical attacks. DMTs come in three forms — oral medications, injections, and intravenous (IV) infusions — providing flexible options based on a person’s individual needs and preferences.

The following DMTs are currently approved by the FDA for MS treatment:

• Alemtuzumab (Lemtrada)
• Cladribine (Mavenclad)
• Dimethyl fumarate (Tecfidera)
• Diroximel fumarate (Vumerity)
• Fingolimod (Gilenya, Tascenso ODT)
• Glatiramer acetate (Copaxone, Glatopa)
• Interferon beta-1a (Avonex, Rebif)
• Interferon beta-1b (Betaseron, Extavia)
• Mitoxantrone
• Monomethyl fumarate (Bafiertam)
• Natalizumab (Tysabri), along with biosimilars such as Tyruko
• Ocrelizumab (Ocrevus)
• Ocrelizumab and hyaluronidase-ocsq (Ocrevus Zunovo)
• Ofatumumab (Kesimpta)
• Ozanimod (Zeposia)
• Peginterferon beta-1a (Plegridy)
• Ponesimod (Ponvory)
• Siponimod (Mayzent)
• Teriflunomide (Aubagio)
• Ublituximab (Briumvi)

The FDA regularly reviews new DMTs for MS, and some may not be listed here. Always consult with your doctor about the best DMT options for you.

Drugs and Treatments Currently in Clinical Trials

MS treatment is constantly evolving, with several promising therapies currently in various stages of clinical trials. These drugs are not yet approved by the FDA for treating MS, but they may be moving toward federal approval. These emerging therapies could offer hope for more effective MS treatments in the future, but it’s important to remember they are still being tested and are not yet available for general use. Here are a few notable examples.

Bruton’s Tyrosine Kinase Inhibitors

Bruton’s tyrosine kinase (BTK) inhibitors, such as evobrutinib, are being studied for their ability to reduce inflammation and protect nerve cells by targeting immune cells involved in MS.

Stem Cell Therapies

Stem cell therapies involve the use of stem cells to repair or replace damaged cells and tissues in the body. In MS, stem cell treatments aim to either regulate the immune system or repair the damage done to nerve cells.

Mesenchymal stem cell (MSC) transplantation is being investigated for its potential to modulate the immune system and promote repair in people with patients. In MSC therapy, stem cells derived from sources like bone marrow or fat are administered to help control inflammation and potentially promote tissue repair.

Autologous hematopoietic stem cell transplant (AHSCT), another type of stem cell therapy, involves using the person’s own blood-forming stem cells. In this procedure, a person’s immune system is suppressed. Then, stem cells previously collected from the individual are reinfused to “reset” their immune response. AHSCT has been shown to reduce relapses and stabilize or even reduces disability in relapsing-remitting MS.

Neuroprotective Agents

Drugs like lipoic acid are being studied for their potential to protect nerve cells from damage in MS. These neuroprotective agents work by targeting the mechanisms that lead to nerve cell damage, helping to preserve brain volume and function.

Remyelination Therapies

Compounds like clemastine fumarate are being studied for their ability to promote the repair of myelin, the protective sheath around nerve fibers damaged in MS. These therapies aim to stimulate new myelin growth on damaged nerves, potentially restoring nerve function and reducing disability.

Nonapproved Medications for Off-Label Treatment

While disease-modifying therapies are essential in altering the course of MS, other medications are often used off-label to manage MS symptoms. Off-label use means that a drug isn’t specifically approved by the FDA to treat MS, but your doctor may prescribe it based on specific symptom needs. In certain cases, medications affecting the immune system may also be used off-label to help prevent MS activity when approved DMTs aren’t suitable.

For Pain

Low-dose naltrexone has shown potential as an off-label treatment for MS-related pain, due to its anti-inflammatory properties. Some studies suggest it may help improve pain symptoms and quality of life for people with MS, with generally mild side effects, such as vivid dreams and headaches.

One MyMSTeam member shared, “Low-dose naltrexone really changed my life for the better. I’ll probably never stop using it.”

Another member mentioned, “For pain try using a heating pad on the area that is giving you problems. That’s what I had to do yesterday and it worked great for me. Good luck to you!”

For Mood

Depression is a common comorbidity in MS. While antidepressants don’t treat MS itself, they may be prescribed to help manage depressive symptoms in individuals with MS. Be aware that antidepressants also have many potential side effects, including changes in weight and fatigue.

For Fatigue

To ease MS-related fatigue, amantadine (Gocovri, Osmolex ER) has shown positive effects in several trials, and it’s often prescribed off-label.

Other options include wakefulness-promoting drugs such as modafinil (Provigil) and certain amphetamines, like methylphenidate (Concerta).”

Other options include wakefulness-promoting drugs such as modafinil (Provigil) and certain amphetamines, like methylphenidate (Concerta). While these medications don’t treat MS directly, they may alleviate severe fatigue. Common side effects include dizziness, headache, and anxiety.

For Movement

As with other MS symptoms, some medications have received FDA approval specifically to address movement-related issues in people with MS. One such medication is dalfampridine (Ampyra), which has been shown to improve ambulation (walking ability) in people with MS, though it does not alter the progression of the disease.

Additionally, certain medications may be prescribed off-label to help manage MS-related movement challenges, such as tremors, gait (walking) difficulties, and spasticity, which involves muscle stiffness and involuntary spasms. Off-label treatments may be considered when approved options are insufficient, less effective, or not well-tolerated. Some benzodiazepines may help relieve these symptoms, though they carry a potential for dependence or misuse. Antiepileptic medications are also sometimes used to help control spasticity and muscle stiffness in MS.

For Relapses and Overall Therapeutic Effect

Certain immunosuppressant drugs are occasionally used off-label to help manage MS symptoms and reduce relapses. These include mycophenolate mofetil (CellCept), cyclophosphamide, and azathioprine (Azasan, Imuran). Although these medications aren’t FDA-approved for MS, some studies suggest they may be beneficial in certain cases.

Minocycline, an antibiotic, and rituximab (Rituxan), an antibody that targets white blood cells, have also shown promise as a safe and efficient therapeutic tool for managing MS symptoms and relapses.

Work With Your Doctor

It’s crucial to remember that all medications can have side effects, which can vary depending on drug combinations. Always talk with your doctor before starting or changing any medications. Your health care provider can help balance the potential benefits and risks of different treatment options based on your individual situation.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 216,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with MS? Have you tried any off-label or nonapproved treatments for MS? Share your experience in the comments below, or start a conversation by posting on your Activities page.