Medication used in MS

Beta Interferon

From May this year (2002), some patients with multiple sclerosis across the U.K. are likely to qualify for treatment with the drugs beta interferon and glatiramer acetate on the National Health Service as part of a "payment by results" agreement between the Department of Health and five pharmaceutical companies.

The National Institute for Clinical Excellence (NICE) published its final appraisal determination on the effectiveness of beta interferon and glatiramer acetate. NICE has found that on the basis of current prescribing mechanisms, these drugs are not cost-effective for use on the NHS.

However, in their initial findings (the Provisional Appraisal Determination, published in August 2001), NICE recommended that "...the Department of Health...and manufacturers might usefully consider what actions could be taken, jointly, to enable any of the four medicines appraised in this guidance to be secured for patients in the NHS in England and Wales, in a manner which could be considered cost-effective."

Following those considerations, the Department of Health, drug manufacturers and patient bodies have agreed on a way of securing beta interferon on behalf of NHS patients. It will ensure that those patients who meet criteria devised by the Association of British Neurologists (ABN), including those with the relapsing/remitting form of MS and those with secondary progressive MS in which relapses are the dominant feature, can be prescribed these drugs on the NHS in a cost-effective way:

• Eligible patients will be called up by specialist neurologists for assessment to confirm that they meet the ABN criteria and that they will benefit from using the drugs. It is probable that most eligible patients will already be under the care of a specialist neurologist who will arrange this assessment.
• Once the patients have been assessed they will then be prescribed the drug thought to be most likely to be clinically effective for him or her.
• All patients meeting the criteria will be thoroughly assessed to establish the extent of their disability, if any. This is necessary to provide a baseline to monitor the patient's progress with the treatment. Generally, patients will then be seen each year for a further assessment of their condition.
• Implementation of the scheme will be a major undertaking and it may take some time before all potentially eligible patients can be assessed. To help with implementation all the companies involved are funding some of the additional specialist nurses who will be needed.

Groups of patients will be monitored over the lifetime of the scheme and costs to the NHS will be adjusted according to whether expected patient benefits are realised. Cost of treatment in a full year could be in the order of £50 million.

Health Authorities and Primary Care Trusts will be expected to fund these treatments out of their general allocations. Funding treatments under the scheme is a statutory obligation.

The ABN assessment criteria

In Relapsing/Remitting MS:

• The ability to walk at least 100 metres without assistance from another person
• At least two relapses in the past year
• Age 18 years or older

In Secondary Progressive MS:

• The ability to walk at least 10 metres with or without assisistance
• At least two relapses in the past year
• Minimal disability progression in the past two years
• Age 18 years or older

Interferons

Interferons are proteins that are naturally released by the body when inflammation occurs which act to regulate the immune system. One class of interferons, known as the beta interferons, seems to be the best at slowing down inflammatory activity in MS, thereby altering the natural course of the disease. There are two types of beta interferons available to treat MS: Interferon beta-1a and Interferon beta-1b. These interferons help regulate, or modulate, an abnormal immune response in people with MS. This is why they are known as immunomodulatory agents.

As yet no studies have been performed to compare the effectiveness of these two beta interferons, but both reduce the risk of MS relapses. On average, the severity of any relapse is less and the inflammation in the white matter, as observed in MRI, are reduced. In addition to reducing the risk of relapse, studies have shown that Interferon beta-1a can also slow the progression of physical disability. Both types of interferon have to be administered by injection. Interferon beta-1b has been tested in doses that have to be injected every other day under the skin (subcutaneous injection). Interferon beta-1a is a weekly injection into the muscle tissue (intramuscular injection).

Avonex - weekly instramuscular injection

Betaseron - subcutaneous injection every other day

Rebif - subcutaneous injection 3 times a week

Glatiramer Acetate

Glatiramer acetate is a synthetic protein that is injected subcutaneously, every day. Like interferons, it helps regulate or modulate immune response in people with MS and has been shown to reduce the frequency of relapses. A potential side effect of subcutaneous injection is uncomfortable injection-site reactions and lumps.

Treatment of Exacerbations

Oral steroid administered by GP for relapses. Dose depends on severity of relapse and must always be tapered off and not just stopped.

Corticosteroids

Corticosteroids, substances related to the hormones produced by the adrenal glands, are commonly used by physicians to treat exacerbations. Corticosteroids can be administered in a variety of ways. Usually an infusion or drip is used (the medication goes directly into the bloodstream) to administer the corticosteroid known as methylprednisolone. Generally the treatment lasts 3 to 5 days. Corticosteroids used for a long time (i.e., for months at a stretch) could cause side effects. Not every MS relapse is treated with corticosteroids. Mild relapses are often left to themselves: the person rests and waits until things improve with time.

Baclofen

Baclofen is used to help relax certain muscles in your body. It relieves the spasms, cramping, and tightness of muscles caused by medical problems such as multiple sclerosis or certain injuries to the spine. Baclofen does not cure these problems, but it may allow other treatment, such as physical therapy, to be more helpful in improving your condition.

Baclofen acts on the central nervous system (CNS) to produce its muscle relaxant effects. Its actions on the CNS may also cause some of the medicine's side effects. Baclofen may also be used to relieve other conditions as determined by your doctor.

Zanaflex

Zanaflex is a treatment indicated for the management of increased muscle tone associated with spasticity, a condition affecting the central nervous system ("CNS") causing muscle stiffness and rigidity. Spasticity can occur as a result of many CNS disorders, particularly multiple sclerosis and spinal cord injury.

Provigil

PROVIGIL is a unique wake-promoting agent for the treatment of excessive daytime sleepiness (commonly called "EDS") associated with narcolepsy. PROVIGIL has been proven to help people with narcolepsy stay awake. PROVIGIL improves daytime wakefulness, allowing people with narcolepsy to participate in daily activities. It has been found useful in the treatment of fatigue associated with MS.

Epilim

A drug used in the treatment of epilepsy but now being prescribed to some people to help with some symptoms of MS.

Neurontin (Gabapentin)

This medication helps with nerve pain which some people suffer with MS. It is especially effective in the treatment of trigeminal neuralgia (facial nerve pain).

Tegretol

An anticonvulsant that is used in treating epilepsy and trigeminal neuralgia. Is also sometimes used for its diuretic properties to assist treatment for diabetes insipidus. Also given to some people with MS. Also marketed as Carbamazepine.

Detrusitol

Detrusitol is used to treat symptoms of an overactive bladder, for example, urinary frequency, urgency or incontinence

Detrusitol belongs to a group of medicines called antimuscarinics. It helps to control the release of urine by reducing spasm, and relaxing the smooth muscle of the bladder wall. It also increases the storage volume of the bladder, and can act on the brain to delay the desire to urinate.

This medicine is only available with a doctor's prescription.

I am sure there are lots more medications out there for the treatment of MS. If anyone knows of anything else please contact me with a short description of the medication, and I'll add it to the site.