Multiple Sclerosis (MS) is a chronic neurological condition that affects the brain, spinal cord, and optic nerves, disrupting the flow of information throughout the body. This disruption arises from the immune system mistakenly attacking myelin, the protective coating around nerve fibers. While there is no cure for MS, various treatments aim to manage symptoms and slow disease progression, with infusion therapy being a common and effective approach.
How Infusion Therapy Works for MS
Infusion therapy for MS involves delivering medication directly into the bloodstream through an intravenous (IV) line, allowing for quicker absorption and response. These treatments primarily function as disease-modifying therapies (DMTs), which target the underlying immune system dysfunction causing myelin sheath damage. By modulating the immune system, infusions work to reduce inflammation and prevent further damage to the central nervous system.
Infusions are often chosen for their potency and ability to deliver a higher dose of medication, which can lead to less frequent administration compared to daily pills or injections. This direct delivery method is often beneficial for individuals with more aggressive or advanced forms of MS. The goal of these therapies is to reduce the frequency and severity of MS relapses, slow the progression of disability, and limit the formation of new lesions in the brain and spinal cord.
Common Infusion Medications for MS
Several infusion medications are used to treat MS. Ocrelizumab, known by its brand name Ocrevus, targets CD20-positive B cells, a type of white blood cell involved in nerve damage. Ocrevus is used for both relapsing forms of MS and is the first drug approved for primary progressive MS (PPMS).
Natalizumab (Tysabri) functions by preventing immune cells from crossing the blood-brain barrier, thereby reducing inflammation and nerve damage in the central nervous system. It is administered for relapsing forms of MS and decreases relapse rates and slows disability progression. Due to a rare but serious risk of progressive multifocal leukoencephalopathy (PML), patients are monitored for the John Cunningham (JC) virus before and during treatment.
Alemtuzumab (Lemtrada) works by reducing the numbers of B and T lymphocytes, which are types of white blood cells involved in the immune response. This action helps to lessen inflammation and nerve cell damage. Lemtrada is used for individuals with relapsing forms of MS who have not responded well to other medications.
Mitoxantrone (Novantrone) is an immunosuppressive agent that interferes with DNA synthesis and repair mechanisms, suppressing the activity of T cells, B cells, and macrophages. While it can be effective for some forms of progressive MS, its use is more limited today due to potential serious side effects, including cardiac issues and leukemia. Another monoclonal antibody, Ublituximab (Briumvi), also targets CD20-positive B cells and is approved for relapsing forms of MS.
What to Expect During an Infusion
Receiving an MS infusion takes place in a clinical setting. Before the infusion begins, you might receive pre-medications, such as antihistamines, acetaminophen, or corticosteroids, to reduce infusion reactions. Staying well-hydrated and wearing comfortable clothing with easy access to your arms is advisable.
A healthcare professional will insert an intravenous (IV) line, typically into a vein in your arm. The IV line is then connected to tubing that delivers the MS medication at a controlled pace. The duration of an infusion session can vary depending on the specific medication, ranging from a few hours to several hours. For example, Ocrevus is given as two initial 300-mg infusions two weeks apart, followed by 600-mg infusions every six months. Tysabri is administered every four weeks, while Lemtrada involves a five-day initial course, followed by a three-day course one year later.
Monitoring and Managing Infusion Therapy
Monitoring is an important part of MS infusion therapy to assess treatment effectiveness and identify complications. This oversight includes regular blood tests to check blood counts or liver function, and MRI scans to track disease activity and lesion formation. Close observation by healthcare professionals during and after the infusion is standard practice to address any immediate reactions.
Patients may experience side effects that vary by medication. Common infusion reactions include skin reactions (e.g., hives, rash), fever, chills, or fatigue. More serious, though rare, side effects include infections due to the immunosuppressive nature of some DMTs, or conditions like progressive multifocal leukoencephalopathy (PML) with certain medications. The healthcare team manages these effects, which may involve adjusting pre-medications or providing guidance on symptom relief.