Disease-modifying therapy for multiple sclerosis: Nursing pharmacology

Multiple sclerosis, or MS for short, is a chronic and progressive demyelinating disease of the central nervous system. Myelin is the protective sheath that surrounds the axons of neurons, allowing them to quickly send electrical impulses. In MS, demyelination happens when the immune system inappropriately attacks and destroys the myelin. As a result communication between neurons breaks down, ultimately leading to various sensory, motor, and cognitive problems. Although there’s no cure for MS, disease-modifying therapy can be used to help slow the disease progression, as well as mitigate some of the symptoms, and ultimately improve the client’s quality of life.

Now, disease-modifying therapy for MS includes monoclonal antibodies and immunomodulators. The most commonly used monoclonal antibodies for MS include rituximab, natalizumab, ocrelizumab, and alemtuzumab, which are administered intravenously. On the other hand, immunomodulators for MS include dimethyl fumarate, teriflunomide, and fingolimod, which are administered orally, as well as glatiramer and recombinant human interferon beta-1a and interferon beta-1b, which can be injected intramuscularly or subcutaneously.

Once administered, these medications blunt the inflammatory process, which ultimately helps reduce the severity and frequency of relapses or exacerbation of multiple sclerosis.

Unfortunately, these medications can cause side effects like bone marrow suppression, which can result in anemia, thrombocytopenia, leukopenia, and an increased risk for infections. In fact, for alemtuzumab, that’s a boxed warning, with an increased risk of developing fatal infections, autoimmune effects, and malignancy.

Clients on disease-modifying therapy may also experience drowsiness, fatigue, nausea, vomiting, and diarrhea. These medications may also result in hypersensitivity reactions, such as injection site reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, and anaphylaxis, while alemtuzumab and rituximab have a boxed warning for potentially causing fatal infusion reactions after administration, and rituximab may also cause fatal mucocutaneous reactions.