Monoclonal Antibodies for Multiple Sclerosis: Do They Halt Disease Progression?
Key takeaways:
Monoclonal antibodies (MAbs) are some of the most effective multiple sclerosis (MS) medications available. They work by interfering with different parts of your immune system that mistakenly attack your brain and spinal cord.
MAbs can slow down how MS progresses over time. But they can’t stop MS entirely or reverse it. Kesimpta (ofatumumab), Briumvi (ublituximab-xiiy), and Lemtrada (alemtuzumab) are a few examples of MAbs that treat MS.
MAb medications for MS come with potential side effects. These include infusion reactions, injection-site reactions, and infection. Rare but serious side effects, such as progressive multifocal leukoencephalopathy, are also possible.
Table of contents
Multiple sclerosis (MS) is a health condition that affects your central nervous system. This includes your brain and spinal cord. Your immune system mistakenly attacks a part of your nerves called myelin. This can gradually result in symptoms such as difficulty walking, confusion, and vision problems.
There’s no cure for MS. But many treatments are available to help manage your symptoms and slow down disease progression. Some of the newest MS treatments are injectable medications called monoclonal antibodies (MAbs). These biologic medications interfere with specific parts of your immune system to treat MS.
MAbs are effective therapies overall. But finding the right treatment can feel overwhelming, and there’s a lot to know about these complex medications. Here, we’ll summarize how MAbs can help make a difference in MS.
Which monoclonal antibodies are used for multiple sclerosis?
Several monoclonal antibodies are used to manage MS over time. They include:
Kesimpta (ofatumumab)
Briumvi (ublituximab-xiiy)
Lemtrada (alemtuzumab)
Ocrevus (ocrelizumab)
Tysabri (natalizumab)
Tyruko (natalizumab-sztn), a biosimilar to Tysabri
There are some important differences to note between these MS medications. Ocrevus is the only FDA approved monoclonal antibody that can treat primary progressive MS. This is a type of MS where symptoms gradually get worse over time. Others just treat relapsing forms of MS, which Ocrevus also treats. Kesimpta is the only MS MAb that you can self-inject at home. The other options are typically administered at a neurology clinic or infusion center.
Biologic infusions: Understand what to expect and how to prepare to receive a monoclonal antibody infusion.
Multiple sclerosis injections: Learn the ins and outs of injectable multiple sclerosis (MS) medications that you can give yourself or receive at a neurology clinic.
MS tablets and capsules: Discover MS medications that you can take by mouth as an oral pill.
Each MAb has different benefits and risks. And your treatment choice depends on several factors, including the type of MS you have. You’ll also want to consider your preference for how to receive the medication.
How do monoclonal antibodies work for multiple sclerosis?
MS treatments, including MAbs, generally work by interfering with specific parts of your immune system. They aren’t one in the same, though.
For example, Kesimpta and Ocrevus are thought to work by indirectly destroying B cells, an immune cell that goes rogue in MS. Briumvi and Rituxan work similarly to this. Lemtrada indirectly destroys B cells and T cells, which are another type of immune cell.
Tysabri has a different approach. It acts like a security guard. It attaches to immune cells and keeps them from going into your brain and spinal cord, preventing damage and inflammation.
All of these MAbs have more specific targets than older treatments for MS, such as glatiramer acetate (Copaxone). We don’t know exactly how glatiramer acetate works. But it’s possible that glatiramer acts like a decoy that your immune system attacks instead of your nervous system.
Good to know: No matter which MAb treatment you receive, it's important to follow your neurologist's administration instructions. This, along with regular checkups, will give you the best chance of reducing your MS symptoms.
How effective are monoclonal antibodies for multiple sclerosis?
Broadly speaking, MAbs are some of the most effective MS treatments available today. Clinical trials show that these medications can reduce relapses (flare-ups). They can also slow down worsening MS-related disability.
Ocrevus, Kesimpta, and other MS MAbs are very effective at reducing relapses and brain lesions (damage to your brain). In fact, some data is available comparing these treatments to older MS medications, such as interferon beta-1a. One study found that Ocrevus reduced annual relapse rates by more than 40% compared to interferon beta-1a. Another study found that Kesimpta is more effective than teriflunomide, an oral MS medication, at reducing annual relapse rates.
Your neurologist will determine the right MAb for you based on factors like effectiveness, safety, and your lifestyle. Regular discussions with your neurologist will help ensure your medication is treating your MS as best it can.
Good to know: It’s hard to directly compare the effectiveness of different MS MAbs. They’ve each been studied in their own clinical trials under different conditions. And they haven’t been widely compared to each other.
Do monoclonal antibodies halt multiple sclerosis disease progression?
MAbs are disease-modifying therapies (DMTs). This means that they slow down how MS worsens over time. They can also reduce MS flare-ups. However, they aren’t a cure and don’t necessarily stop MS entirely.
MAbs help reduce the amount of new damage to your brain and slow down disability due to MS. Some people still experience worsening MS, but it happens at a much slower pace than it would without treatment.
Early treatment with highly effective medications can minimize your likelihood of relapse with certain types of MS. One goal of MAb therapy is to prevent further damage to your brain and spinal cord. Another goal is to minimize disability.
Can you combine monoclonal antibodies with other multiple sclerosis treatments?
Sometimes. An MAb is most often combined with a short-term MS medication in cases of relapse or sudden worsening of MS symptoms.
For example, you might treat an MS flare-up with a corticosteroid such as methylprednisolone (Medrol). Corticosteroids can reduce inflammation during a flare-up. And MAbs are used long term to prevent further relapses.
However, if you’re experiencing frequent flare-ups, your maintenance treatment may not be right for you. If this is the case, your neurologist may switch you to a different DMT.
What are the side effects of monoclonal antibodies for multiple sclerosis?
MAbs have revolutionized how neurologists treat MS. Side effects are possible, but most of them can be monitored and managed proactively.
The most common side effects associated with MS MAbs are infusion-related reactions. These are common with medications that are administered into a vein. Infusion reaction symptoms include:
Fever
Rash
Hives
Coughing or wheezing
Nausea
Headache
Feeling like you can’t catch your breath
Your neurologist may give you supportive medications before your infusion. This is to help manage these symptoms before they start. These medications might include corticosteroids, antihistamines, or acetaminophen (Tylenol).
Medications that are injected under the skin, such as Kesimpta, are sometimes associated with injection-site reactions. Injection symptoms may include redness, swelling, and pain in the area where you inject Kesimpta.
Serious reactions to MAbs are rare, but possible. Lemtrada has a boxed warning, the FDA’s most serious medication warning, for rare but serious infusion reactions. It also has warnings for stroke, cancer, and sudden autoimmune reactions.
Infection-related risks
Infections are a relatively common MAb side effect. Most infections aren’t serious, but some can be. To play it safe, let your neurologist know if you have a fever, chills, or a cough that doesn’t go away. It’s also important to tell them if you develop a skin rash, cold sores, or itchy skin.
In rare cases, MAb medications have been linked to progressive multifocal leukoencephalopathy (PML). PML is a serious brain infection caused by the John Cunningham virus (JCV). Certain MAbs, like Tysabri, may have a greater risk of PML than others. PML symptoms may include:
Clumsiness
Weakness
Difficulty speaking
Vision loss
Facial drooping
Seizures
Memory loss
The risk of PML increases the longer you have been receiving an MAb for MS. Your risk is also higher if you have a weakened immune system or higher levels of JCV antibodies. Having high levels of JCV antibodies means you were exposed to JCV at some point in your life and your immune system reacted strongly to it.
Tysabri, specifically, has a boxed warning for PML. It’s only available through the TOUCH Prescribing Program as a result. But PML is possible with any MAb that treats MS. Your neurologist will likely order tests before you start your treatment. And they’ll likely monitor you during treatment to catch any early signs of PML.
The bottom line
Monoclonal antibodies (MAbs) are recommended and effective options for treating multiple sclerosis (MS). They work by targeting specific parts of your immune system to reduce relapses and slow down MS progression. MAbs can cause side effects such as infusion reactions, injection-site reactions, and infections. But these are typically manageable through regular appointments with your neurologist. Serious side effects, such as progressive multifocal leukoencephalopathy, are also possible, but they’re rare.
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