These MS treatments help provide relief during a relapse, which is when symptoms suddenly appear, or get worse, and last for 24 hours or more. Some relapses get better on their own, whereas others get better with treatment.

Corticosteroids

These are hormones that act on your immune system to reduce inflammation.

There are many ways to help manage your symptoms, and the approach needed will be unique to you and the symptoms you are experiencing

Approaches to symptom management can include specific exercises to target different symptoms, and diet and lifestyle changes, to maintain your overall health and well-being. 

Your neurologist may refer you to receive additional help with a specific issue. This could include: 

• Occupational therapy
• Physiotherapy
• Speech and language therapy
• Psychological therapies

Occupational therapy

An occupational therapist can give you tips to manage your day-to-day activities. They can help you plan how to deal with specific symptoms (e.g. fatigue, tremors, and unsteadiness) to reduce their impact on your work, social life, and daily life. 

Physiotherapy

If you have experienced a relapse or have long-lasting symptoms, physiotherapy can help because it focuses on physical movement and exercises to help target and manage specific symptoms, such as mobility and muscle spasms, as well as help you to maintain your overall fitness. 

Speech and language therapy 

If you are having problems with speech or swallowing, speech and language therapists may be able to help with these symptoms. They will work with you to identify the causes of these symptoms and develop strategies to help alleviate them. For example, they might provide exercises that focus on breathing during speech or that directly train the muscles involved in producing sounds. 

Psychological therapy

Psychological therapies help with the management of mental health problems such as depression and anxiety. ‘Talking’ therapies can help train your brain to react positively to certain situations and help you find constructive ways of thinking about your MS, improve your mental well-being, and help you deal with how MS is affecting your lifestyle. 

Read more about psychological therapies on our mental health page. 

These therapies target the immune system. Although disease-modifying therapies can’t reverse the nerve damage already caused by MS, they can reduce how often relapses happen in certain forms of MS. 

There are now many disease-modifying therapies available that vary in terms of the effect they have on your MS, their side effects, how they are administered, how frequently they are taken, and what follow-up tests are needed to monitor their impact. 

It’s important to discuss with your neurologist which kind of administration suits you and your lifestyle, as well as considering the side effect profile of each drug. For further information, talk to your healthcare team and refer to the patient information leaflets provided for each of the drugs.

The table below includes an overview of some of the different disease-modifying therapies available, including how they are taken, how often, and what follow-up assessments are needed to assess their impact – think about what might fit best with your daily life.

Disease-Modifying Therapy (DMT)^†

Drugs included below are grouped by how they are administered and listed in alphabetical order.

Taken as a tablet or capsule (also known as oral administration)

Cladribine

Indication: Indicated for the treatment of adults with relapsing-remitting multiple sclerosis to reduce the frequency of clinical exacerbations and delay the progression of disability.

Frequency of maintenance dose: A two-year treatment, followed by another two years of observation. In the first year, the treatment course includes two treatment weeks, which consist of one or two tablets per day during 4–5 days at the beginning of the first month and 4–5 days at the beginning of the second month of the same year.

The same treatment course is repeated in second year.

Possible side effects:^‡

• Nausea
• Headache
• Cold sores
• Rash
• Thinning or hair loss
• Fever
• Abdominal pain
• Toothache
• Flu and flu-like symptoms
• Cold symptoms
• Bronchitis or other chest infections
• Symptoms of gastroenteritis (diarrhea, vomiting, abdominal pain)
• Back pain
• Anxiety
• Vaginal infection

Serious side effects:^‡

• Decreased white blood cells
• Shingles

Dimethyl fumarate

Indication: Indicated for the treatment of relapsing remitting multiple sclerosis to reduce the frequency of clinical exacerbations and to delay the progression of disability.

Frequency of maintenance dose: Twice a day as a capsule

Possible side effects:^‡

• Diarrhea
• Nausea
• Stomach pain or stomach cramps
• Vomiting
• Indigestion

Serious side effects:^‡

• Flushing
• Gastrointestinal events
• Decreased white blood cells
• Proteins in urine
• Abnormal liver function tests
   

Fingolimod

Indication: In adults - Indicated for the treatment of patients with the relapsing-remitting form of multiple sclerosis to reduce the frequency of clinical exacerbations and to delay the progression of physical disability.

In children - Indicated for the treatment of pediatric patients of 10 years to below 18 years of age with relapsing multiple sclerosis to reduce the frequency of clinical exacerbations.

Frequency of maintenance dose: Once a day as a capsule

Possible side effects:^‡

• Flu virus infection
• Headache
• Diarrhea
• Back pain
• Cough
• Sinusitis
• Fungal infections affecting skin, nails or hair
• Dizziness
• Migraine
• Weakness
• Mild increase in blood pressure
• Skin rash
• Hair loss
• Itchy skin
• Weight loss
• Blurred vision
• Breathlessness
• Tingling or numbness
• Depression
• Eye pain

Serious side effects:^‡

• Shingles
• Bradycardia (slow heartbeat)
• Basal cell carcinoma
• Decreased white blood cells
• Very rare fatal cases of chicken pox

Siponimod

Indication: Indicated for the treatment of patients with secondary progressive multiple sclerosis, specifically SPMS with active disease (patients with relapses or scans with signs of inflammation), to delay the progression of physical disability.

Frequency of maintenance dose: Once a day as a tablet

Possible side effects:^‡

• Headache
• Dizziness
• Involuntary shaking of the body (tremors)
• Diarrhea
• Nausea
• Pain in hands and feet
• Swollen hands, ankles, legs or feet
• Weakness or lack of energy

Serious side effects:^‡

• Hypertension (high blood pressure)
• Herpes zoster
• Melanocytic nevus (a type of tumors—moles)
• Lymphopenia (low white blood cells)
• Seizures
• Macular edema (swelling and build-up of fluid in the center of the retina)
• Atrioventricular block (irregular heartbeat)
• Bradycardia (abnormally slow heartbeat)
• Trouble breathing

Teriflunomide

Indication: Indicated for the treatment of patients with secondary progressive multiple sclerosis, specifically SPMS with active disease (patients with relapses or scans with signs of inflammation), to delay the progression of physical disability.

Frequency of maintenance dose: Once a day as a tablet

Possible side effects:^‡

• Diarrhea
• Nausea
• Flu or sinus infection
• Upset stomach
• Abdominal pain
• Rash
• Abnormal liver function tests
• Hair thinning or loss

Serious side effects:^‡

• Decreased white blood cells
• High blood pressure
• Liver problems

Taken as an injection (which can be done yourself at home)

Glatiramer acetate (3 times per week)

Indication: Indicated for the treatment of ambulatory patients^§ with relapsing remitting multiple sclerosis, to decrease the frequency of clinical exacerbations and to reduce the number and volume of active brain lesions identified on MRI scans

Frequency of maintenance dose: Injection under the skin daily or 3 times per week (at least 48 hours apart)

Possible side effects:^‡

• Skin reactions at the injection site
• A permanent “dent” under the skin at the injection site
• Rash
• Hives
• Headache
• A feeling of worry, nervousness and unease (anxiety)

Serious side effects:^‡

• Post-injection reaction
• Low blood pressure
• High blood pressure
• Breathing problems
• Irregular heartbeat
• Angioedema (swelling of the arms, legs or face)
• Depression
• Changes to vision
• Chest/back/neck/joint pain

Glatiramer acetate (daily)

Indication: Indicated for the treatment of ambulatory patients^§ with relapsing remitting multiple sclerosis:

• To decrease the frequency of clinical exacerbations
• To reduce the number and volume of active brain lesions identified on MRI scans

Frequency of maintenance dose: Injection under the skin daily

Possible side effects:^‡

• Skin reactions at the injection site
• A permanent “dent” under the skin at the injection site

Serious side effects:^‡

• Post-injection reaction
• Low blood pressure
• High blood pressure
• Breathing problems
• Irregular heartbeat
• Chest, back, neck, or joint pain
• Angioedema (swelling of the arms, legs or face)
• Depression
• Changes to vision

Interferon beta-1a (once per week)

Indication: Indicated for the treatment of :

• relapsing forms of multiple sclerosis to slow the progression of disability, decrease the frequency of exacerbations and reduce the number and volume of active brain lesions identified on MRI scans
• people who have experienced a single demyelinating event, accompanied by abnormal MRI scans, with lesions typical of MS, to delay the onset of clinically definite MS and decrease the number and volume of active brain lesions and overall disease burden

Frequency of maintenance dose: Injection into the muscles once a week

Possible and serious side effects:^‡

• Flu-like symptoms
   

Interferon beta-1a (3 times per week)

Indication: Indicated for the treatment of:

• relapsing forms of multiple sclerosis to slow the progression of disability and reduce the number and severity of exacerbations
• people who have experienced a single demyelinating event, accompanied by an active inflammatory process and an abnormal MRI scan with lesions typical of MS

Frequency of maintenance dose: Injection under the skin 3 times per week

Possible and serious side effects:^‡

• Flu-like symptoms
• Injection site reaction

Interferon beta-1b

Indication: Indicated for:

• the treatment of patients with a single clinical event suggestive of MS accompanied by at least two lesions typical of multiple sclerosis on magnetic resonance imaging, to delay progression to definite MS
• the reduction of the frequency of clinical exacerbations in ambulatory patients with relapsing-remitting multiple sclerosis
• the slowing of progression in disability and the reduction of the frequency of clinical exacerbations in patients with secondary-progressive multiple sclerosis.

Frequency of maintenance dose: An injection under the skin every other day

Possible side effects:^‡

• Skin reactions
• Flu-like symptoms
• Liver problems 
• Blood problems (a decrease in white blood cells, red blood cells, or platelets)

Serious side effects:^‡

• Fluid retention (swelling) in ankles or legs
• Break in skin or drainage of fluid at injection site
• Rash

Interferon beta-1b

Indication: Indicated for:

• the treatment of patients with a single clinical event suggestive of MS accompanied by at least two lesions typical of multiple sclerosis on magnetic resonance imaging, to delay progression to definite MS
• the reduction of the frequency of clinical exacerbations in ambulatory patients with relapsing-remitting multiple sclerosis
• the slowing of progression in disability and the reduction of the frequency of clinical exacerbations in patients with secondary-progressive multiple sclerosis.

Frequency of maintenance dose: An injection under the skin every other day

Possible side effects:^‡

• Skin reactions
• Flu-like symptoms
• Liver problems
• Blood problems (a decrease in white blood cells, red blood cells, or platelets)

Serious side effects:^‡

• Rash
• Break in skin or drainage of fluid at injection site
• Lack of coordination in moving arms, fingers or legs, or other muscular movement
   

Peginterferon beta-1a

Indication: Indicated for the treatment of relapsing remitting multiple sclerosis for adult patients to reduce the frequency of clinical exacerbations and to slow the progression of disability

Frequency of maintenance dose: An injection under the skin once every 2 weeks

Possible and serious side effects:^‡

• Flu-like symptoms
• Injection site reactions
• Abnormal liver function tests
• Headache
• Muscle pain (myalgia)
• Pain in your joints, arms, legs or neck (arthralgia)
• Chills, feeling cold
• Feeling weak and tired (asthenia)
• Feeling sick or being sick (nausea or vomiting)
• Itchy skin (pruritus)
• Increase in body temperature

Taken as an infusion, which is when the treatment is given via a needle directly into your bloodstream (this is performed in a clinic)

Alemtuzumab

Indication: Indicated for the management of adult patients with relapsing remitting multiple sclerosis

Frequency of maintenance dose: As an infusion in 2 treatment courses, 12 months apart, for 5 consecutive days for the initial treatment and 3 consecutive days for the second treatment course

Possible side effects:^‡

• Infusion reactions
• Infections
• Changes in white blood cell counts
• Thyroid disorders
• Pain in the back, neck, arms, joints or other places
• inflammation of the mouth/gums/tongue
• general discomfort, weakness
• vomiting, diarrhea, abdominal pain, gastric flu, hiccups, heartburn
• blood or protein in urine
• decreased/irregular/abnormal heartbeat
• high blood pressure
• impaired kidney function
• white blood cells in urine
• contusion
• MS relapse
• trembling, loss of sensation, burning or prickling sensation
• thyroid problems
• Abnormal liver function tests
• Swelling of arms and legs
• Vision problems
• Vertigo
• Anxiety
• Depression
• Hair loss

Serious side effects:^‡

• Serious and life-threatening infusion reactions
• Serious and life-threatening reactions after infusion including stroke (including ischemic and hemorrhagic stroke), bleeding in the lung, heart attack or tears in blood vessels supplying the brain have been reported within 3 days of administration.
• May cause an increased risk of malignancies such as thyroid cancer, melanoma and lymphoproliferative disorders.
• Serious and fatal autoimmune immune and mediated conditions including immune thrombocytopenic purpura (low platelets), liver inflammation, liver injury, excessive activation of white blood cells associated with inflammation (Hemophagocytic lymphohistiocytosis (HLH)) and kidney disease have occurred
• Serious and rare viral infection of the brain which can cause serious illness or death
• Thyroid disorders
• Immune thrombocytopenic purpura (ITP)

Natalizumab

Indication: Indicated for the treatment of relapsing remitting for of multiple sclerosis to reduce the frequency of clinical exacerbations, to decrease the number and volume of active brain lesions identified on MRI scans and to delay progression of physical disability.

Frequency of maintenance dose: As an infusion every 4 weeks

Possible and serious side effects:^‡

• There have been uncommon cases of a brain infection by JC virus resulting in progressive multifocal leukoencephalopathy (PML) and/or JCV granule cell neuronopathy (JCV GCN) occurring in patients who have been given this medication. These infections are associated with an uncontrolled increase of the JC virus in the brain, although reason for this increase in some patients is unknown. It usually happens in people with weakened immune systems, but it is difficult to predict who will get these infections. Such infections may lead to severe disability or death; there is no known cure.
• Urinary infection
• Sore throat and runny or blocked nose
• Shivering
• Itchy rash
• Headache
• Dizziness
• Nausea/Vomiting
• Joint pain
• Fever
• Tiredness

Ocrelizumab

Indication: Indicated for adult patients with:

• relapsing remitting multiple sclerosis with active disease defined by clinical and imaging features
• early primary progressive multiple sclerosis as defined by disease duration and level of disability, in conjunction with imaging features characteristic of inflammatory activity. This indication been approved with conditions (NOC/c). This means it has passed Health Canada’s review and can be bought and sold in Canada, but the manufacturer has agreed to complete more studies to make sure the drug works the way it should.

Frequency of maintenance dose: The initial dose is given as 2 separate infusions 2 weeks apart. After this initial dose, it is given as an infusion every 6 months

Possible and serious side effects:^‡

• Infusion reactions
• Infections such as upper respiratory tract infection, common cold, flu, sinus infection, bronchitis, gastroenteritis, respiratory tract infection, viral infection, cold sore or shingles, conjunctivitis

* Dr. Sarah Morrow is a practicing neurologist at an MS Clinic in Canada

† Treatment must be started and supervised by a doctor experienced in treating multiple sclerosis

‡ These side effects are not a comprehensive list of all possible side effects for the individual treatments. Please refer to their individual product monographs for a full list.

§ Including patients who have experienced one episode of nervous system symptoms and who have abnormalities on their brain scan that may be the first signs of multiple sclerosis.