Real Talk Rx: Relapsing Multiple Sclerosis

Medications:

Kesimpta®  | Ocrevus® | Briumvi®  | Vumerity®  | Tysabri® 

Commonly Used Treatment Options

The treatment options commonly used for relapsing MS can be divided into seven major disease-modifying medication classes. These classes include: 

• Anti-CD20 therapies: These medications target certain B cells that contribute to MS damage. Examples include Kesimpta® (ofatumumab), Ocrevus® (ocrelizumab), and Briumvi® (ublituximab-xiiy).
• S1P receptor modulators: These medications keep certain immune cells in the lymph nodes so fewer can reach the brain and spinal cord. Examples include Mayzent® (siponimod), Zeposia® (ozanimod), Gilenya® (fingolimod), Ponvory® (ponesimod), and Tascenso ODT® (fingolimod).
• Fumarates: These medications help reduce overactive immune responses and inflammation that can damage nerve cells. Examples include Vumerity® (diroximel fumarate), Tecfidera® (dimethyl fumarate), and Bafiertam® (monomethyl fumarate).
• Interferon therapies: These medications help reduce immune responses that contribute to inflammation and nerve damage in MS. Examples include Avonex® (interferon beta-1a), Rebif® (interferon beta-1a), Betaseron® (interferon beta-1b), Extavia® (interferon beta-1b), and Plegridy® (peginterferon beta-1a).
• Glatiramer acetate: These medications change how certain immune cells respond, helping reduce attacks on the nervous system. Examples include Copaxone® and Glatopa®.
• Immune reconstitution therapy: This type of medication lowers certain immune cells involved in MS disease activity and then allows the immune system to rebuild. Mavenclad® (cladribine) is one example.
• Cell adhesion inhibitors: These medications help block certain immune cells from entering the brain and spinal cord. Examples include Tysabri® (natalizumab) and Tyruko® (natalizumab-sztn), a highly similar version of Tysabri®.

Therapy and Treatment for RMS

The RMS treatment landscape includes several types of therapy, each with a different purpose. Short-term therapies help manage relapses, while other treatments relieve day-to-day symptoms, support movement and daily function, or address RMS related complications. Disease-modifying therapies are used long term to reduce future relapses and other disease activity. A person’s treatment plan may combine several therapies based on their symptoms, overall health, treatment goals, preferences, and response to treatment. 

Treatment During an MS Relapse

A relapse happens when a new immune system attack causes inflammation, leading to new symptoms or worsening existing symptoms. Relapses are also sometimes called MS exacerbations, acute attacks, or flares. Mild relapses may improve without medication. When symptoms are more severe or interfere with daily activities, high-dose corticosteroids such as methylprednisolone or prednisone, may be used. These steroid medications reduce inflammation and calm the immune system. They can help recovery happen faster but do not change the long-term course of MS.

Corticotropin may be considered for some people who cannot use or tolerate corticosteroids. This hormone-based therapy helps the body produce its own corticosteroids to reduce inflammation and help recovery happen faster.

For a severe relapse that does not improve with corticosteroids, plasma exchange, also called PLEX, may be used. During PLEX, blood passes through a machine that separates the plasma from the blood cells. The plasma is removed because it contains antibodies and other substances that may be contributing to the immune attack. 

The blood cells are then returned to the body with a replacement fluid, usually albumin. Albumin is a protein normally found in the blood that helps maintain fluid levels and blood volume during the exchange. 

These therapies help manage a relapse that is already happening. They do not provide long-term control of MS.

Treatment for Day-to-Day MS Symptoms

RMS can cause symptoms even when a person is not having a relapse. Some symptoms may continue after an earlier relapse, while others may develop gradually as RMS affects different areas of the central nervous system. Medications may be used alone or with other therapies to manage symptoms that affect daily activities. Before prescribing medication, a healthcare provider considers the person’s symptoms, medical history, current medications, other health conditions, and overall health. This overview does not include every symptom used for RMS treatment.

Medication Treatment for Common RMS Symptoms

• Muscle stiffness and spasms: Muscle-relaxing or antispasticity medications may help reduce muscle tightness, stiffness, and involuntary spasms.
• Movement problems: Medications that help messages travel more effectively through damaged nerves may improve walking in some people.
• Nerve pain: Nerve-pain medications may help reduce burning, tingling, stabbing, or electric-like pain.
• Extreme energy loss: Medications may help improve energy.
• Bladder urgency, frequency, or leakage: Bladder-control medications may help reduce these symptoms.
• Depression or anxiety: Medications may help improve mood and reduce symptoms, sometimes along with counseling or mental health therapy.
• Symptom treatment does not slow RMS progression. The purpose is to help with comfort, movement, sleep, mood, bladder or bowel function, and other everyday activities.

Rehabilitation and Supportive Therapies

Medication is only one part of RMS treatment. Rehabilitation and supportive therapies can help manage symptoms and support strength, movement, safety, independence, and daily function. The type of therapy used depends on the person’s symptoms and everyday physical limitations.

Physical Therapy

Physical therapy can improve strength, balance, walking, and flexibility while helping prevent falls. The goals are to preserve safe mobility and independence at home.

Physical therapy may include:

• Stretching, range-of-motion exercises, and positioning for muscle stiffness
• Gait and balance training
• Regular exercise to support strength and movement
• Braces, canes, walkers, wheelchairs, and other mobility aids to support safer movement and greater independence
• Bladder training or pelvic-floor physical therapy for certain bladder problems

Occupational Therapy
Occupational therapy helps people complete everyday tasks in safer and less tiring ways. The goals are to make daily activities easier and support independence.

Occupational therapy may include:

• Activity planning and scheduled rest breaks
• Dividing larger tasks into smaller steps, and keeping commonly used items within easy reach
• Home improvements, such as grab bars and shower chairs
• Tools for daily tasks, such as reachers and dressing aids

Speech-Language Therapy

Speech-language therapy helps with speech, voice, communication, and swallowing problems. The goal is to support clear communication and safer eating and drinking.

Speech-language therapy may include:

• Exercises to improve speech clarity
• Exercises for the muscles used in speaking and swallowing
• Communication tools when speaking becomes difficult
• Safer ways to eat and drink when swallowing problems are present

Cognitive Rehabilitation and Behavioral Therapy

Cognitive rehabilitation helps with memory, attention, planning, and organizing daily activities. Behavioral therapy may help with stress, sleep changes, depression, anxiety, and the emotional effects of living with RMS. The goals are to support thinking, emotional health, and daily function.

These therapies may include:

• Memory exercises
• Step-by-step routines
• Written reminders and calendars
• Electronic alerts and other organizational tools
• Daily routines
• Ways to manage difficult thoughts and emotions

Other Supportive Therapies

Other supportive therapies can address needs that do not fit within one type of rehabilitation. The goal is to support overall health and daily life.

These therapies may include:

• Nutrition guidance
• Bowel-management methods
• Sexual health support
• Caregiver education

Rehabilitation and supportive therapies do not slow RMS disease activity or replace disease-modifying therapies. Their overall goal is to improve symptoms, preserve independence, and make everyday activities safer and easier.

Complementary therapies

Some people use yoga, tai chi, mindfulness or meditation, massage, acupuncture, and vitamin D supplements to support symptom management. These approaches may complement standard RMS treatment for some people, but  research does not support using them alone. Talk with a healthcare provider before starting a new exercise program or taking supplements or herbal products. Supplements and herbal products can cause side effects or interact with medications, and exercise should be matched to the person’s health and abilities.

Specialty Treatment for RMS Complications

Damage caused by RMS can sometimes lead to additional complications. This overview does not include every problem that may occur. A specialist may be needed if these problems are severe, unusual, do not improve, or affect vision, walking, swallowing, or bladder control.

Vision Problems

Optic neuritis is a complication that causes swelling of the nerve that carries messages from the eye to the brain. This condition can cause blurry vision, vision loss, pain with eye movement, or changes in color vision. A neurologist or eye specialist is needed if vision changes are severe, unusual, or difficult to explain.

Severe Muscle Stiffness and Spasms

When severe muscle stiffness or spasms do not improve with medication and therapy, a specialist may recommend that a small pump be placed under the skin through surgery. This pump delivers medication into the fluid around the spinal cord close to the affected nerves to reduce stiffness and spasms.

Severe Shaking and Coordination Problems

A neurologist may be needed when severe shaking, called tremors, or coordination problems affect daily activities and do not improve with routine therapies. Specialty treatment may include prescription medications or targeted muscle injections.

Joint Problems

Long-term stiffness, weakness, or limited movement can cause joints to become tight and difficult to move. An orthopedic doctor may recommend additional treatment, including surgery in some cases, if pain or limited movement affects daily activities.

Specialty treatments and procedures do not treat RMS disease. Their goal is to manage specific complications that have not improved with other treatments.

Reducing Future RMS Activity With DMT

Disease-modifying therapies, or DMTs, are the main medications used for long-term control of RMS. They do not cure MS and are not used to stop an active relapse or relieve day-to-day symptoms such as pain, extreme energy loss, or muscle stiffness.
Instead, DMTs act on the disease process to help:

• Reduce the number of relapses
• Decrease new or enlarging MS lesions seen on MRI
• Reduce other signs of active MS
• Lower the chance that movement, thinking, or daily activities worsen over time

Each DMT affects the immune system differently, but all are designed to reduce future MS disease activity.

• Cell adhesion inhibitors: These medications help block certain immune cells from entering the brain and spinal cord. Examples include Tysabri® (natalizumab) and Tyruko® (natalizumab-sztn), a highly similar version of Tysabri®.

Although these medications work in different ways, they share the same long-term goal to reduce future MS disease activity. No single DMT is best for everyone with RMS. When recommending a medication, the healthcare team considers:

• Type and Stage of MS
• Previous relapses
• Other health conditions
• Infection risk
• Pregnancy plans
• Laboratory results
• Previous medications
• Possible medication risks

A person’s daily life and preferences also matter. Some DMTs are taken at home, while others require visits to an infusion center. Some are taken daily or monthly, while others are given only a few times each year. Testing and monitoring requirements also differ among medication classes.

Choosing a DMT means balancing how well the medication controls MS, its possible risks, the monitoring it requires, and how well it fits the person’s health needs and daily life.

Key Takeaways

• RMS does not affect everyone the same way. Symptoms depend on where damage occurs in the brain or spinal cord and may come and go or resemble other health problems.
• Relapse therapies are used to shorten recovery from an active relapse but do not provide long-term control of MS.
• Medications and rehabilitation therapies are used to manage symptoms, improve safety, and support daily function and independence.
• Complementary therapies should be discussed with the healthcare team before taking them
• DMTs reduce future RMS activity and lower the chance that physical or thinking problems will worsen over time. They do not cure MS or directly relieve day-to-day symptoms.
• DMT selection depends on the type and stage of MS, health history, medication risks, monitoring needs, and how well the therapy fits the person’s daily life.

Conclusion

Learning about treatment choices can help patients take a more active role in managing relapsing MS care. The medications featured represent ways to treat different forms or stages of relapsing MS, and each has its own benefits, risks, testing needs, and side effects. Your healthcare providers should share why a medication is being recommended, what other therapies or treatment options might work, and what support is available to you. All patients should seek clear information, timely care, and a treatment plan that fits their needs.

This guide is not intended to provide a comprehensive list of all available treatments for relapsing MS. The medications featured represent a selection of established and emerging treatment approaches that may be considered at different stages of the MS journey. Treatment decisions are individualized and depend on a number of factors. Patients should talk with their healthcare team about the full range of treatment options that may be appropriate for them. 

References

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4. US Department of Veterans Affairs, Pharmacy Benefits Management Services, National Formulary Committee. Disease Modifying Therapies in Multiple Sclerosis: National Clinical Recommendations. Published June 2024. Accessed August 20, 2026. 
5. US Department of Veterans Affairs. Relapse management for multiple sclerosis. Multiple Sclerosis Centers of Excellence. Accessed August 20, 2026. 
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8. Lysogorskaia E, Ivanov T, Mendalieva A, Ulmasbaeva E, Youshko M, Brylev L. Yoga vs physical therapy in multiple sclerosis: results of randomized controlled trial and the training protocol. Ann Neurosci. 2023;30(4):242-250. doi:10.1177/09727531231161994
9. Simpson R, Posa S, Langer L, et al. A systematic review and meta-analysis exploring the efficacy of mindfulness-based interventions on quality of life in people with multiple sclerosis. J Neurol. 2023;270(2):726-745. doi:10.1007/s00415-022-11451-x
10. Dogahe SJ, Pakravan P, Pakravan M. Acute optic neuritis: an update on approach and management. J Ophthalmic Vis Res. 2023;18(4):433-440. doi:10.18502/jovr.v18i4.14556

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking any drug or commencing or discontinuing any course of treatment.