When considering which medications are best for **progressive multiple sclerosis (MS)**, it’s important to understand that progressive MS includes two main types: **primary progressive MS (PPMS)** and **secondary progressive MS (SPMS)**. These forms are characterized by a gradual worsening of neurological function over time, often without the clear relapses and remissions seen in relapsing-remitting MS (RRMS). Treating progressive MS is more challenging because the disease mechanisms involve not only immune system attacks but also neurodegeneration and nerve damage.
Several medications have been developed and approved to target progressive MS, especially forms with active inflammation. Here’s a detailed look at the main options and how they work:
**Ocrevus (ocrelizumab)** is currently the most widely recognized and approved treatment for both **primary progressive MS** and **active secondary progressive MS**. It is a monoclonal antibody that targets a specific type of immune cell called CD20-positive B cells, which play a role in the autoimmune attack on the nervous system. Ocrevus is given by intravenous infusion every six months and has been shown to reduce relapses and slow disability progression in PPMS and active SPMS. It can take several months to see the full effects, and while it reduces disease activity, it does not cure MS. Side effects can include infusion reactions and increased risk of infections, so patients are monitored closely during treatment.
**Mayzent (siponimod)** is an oral medication approved for relapsing forms of MS, including active SPMS. It works by modulating sphingosine-1-phosphate receptors, which affects immune cell movement and reduces their ability to attack nerve cells. Clinical trials have shown that Mayzent can slow disability progression, especially in younger patients with active lesions and less accumulated disability. Its benefits in inactive SPMS are less clear, but it may still help some individuals. Mayzent is taken daily and requires monitoring for heart rate and liver function due to potential side effects.
**Vumerity (diroximel fumarate)** is another oral disease-modifying therapy (DMT) used for relapsing forms of MS, including active SPMS. It is similar to Tecfidera (dimethyl fumarate) but tends to cause fewer gastrointestinal side effects. Vumerity works by reducing inflammation in the central nervous system, likely through antioxidant and immune-modulating effects. It helps decrease relapses and new MRI lesions, which can indirectly slow progression in active SPMS.
**Zeposia (ozanimod)** is also an oral medication approved for relapsing MS forms and active SPMS. It reduces the number of lymphocytes in the bloodstream, limiting their ability to attack nerve cells. Zeposia has been shown to reduce relapses and brain lesions, contributing to slower disease progression in active cases. It is taken once daily and requires monitoring for heart-related side effects and infections.
Other medications like **fingolimod** have been studied for progressive MS, particularly PPMS, but their effectiveness is still under investigation. Fingolimod traps immune cells in lymph nodes, preventing them from reaching the brain and spinal cord. It may also have neuroprotective effects by crossing the blood-brain barrier, but more research is needed to confirm benefits in progressive MS.
Emerging therapies are also in development, such as **vidofludimus calcium**, which has shown promise in delaying disability worsening in progressive MS by targeting immune pathways involved in nerve damage. This drug is still experimental but represents hope for future treatment options.
In summary, the best medications for progressive MS currently focus on slowing disease progression and managing active inflammation. Ocrevus stands out as the primary approved treatment for both PPMS and active SPMS. Oral options like Mayzent, Vumerity, and Zeposia offer alternatives for active SPMS, especially for patients who prefer oral therapy. Treatment choice depend
