Comparison Review of MS Drugs

 

By Editorial Team

Disease-modifying therapies (DMTs) are currently the best way to prevent relapses and slow the disability of multiple sclerosis (MS). There are several DMTs available on the market, which are listed below. When considering which treatment is best, each individual should talk to their doctor about the treatment options that are right for their unique situation, as well as all the potential benefits and risks of each treatment.¹

Treatment experiences can vary

MS is a disease that greatly varies in how it affects different people, the frequency and severity of relapses or exacerbations, the symptoms presented, and the rate of disease progression. How well a particular drug works in one person may be different from how well it works in another person. It is helpful to keep in mind these variations between people when considering which treatment to choose.

Considerations when choosing between different treatments

Common considerations when choosing between different treatments include:

• Cost
• Effectiveness in preventing new relapses
• Side effects/safety
• Route of administration

Cost of different MS treatments

Cost will vary based on each individual’s health insurance coverage and benefits. Several of the drug manufacturers have patient assistance programs that can also help cover the cost of medications.

MS treatment safety and effectiveness

All drugs that receive approval from the US Food and Drug Administration must undergo several controlled clinical trials to prove that the product is effective and safe. However, the degree of effectiveness at preventing relapses and the safety profile differ between DMTs. During some of these trials, new potential treatments may be compared to existing standard treatments, called head-to-head studies.²

Slowing down progression and reducing relapses

However, there is no one trial or source of information that compares all of the current DMTs to each other. All of the DMTs available have demonstrated through clinical trials that they reduce the frequency and severity of relapses in relapsing forms of MS, reduce the development of new MS lesions, and appear to slow down disability progression. Only one DMT, ocrelizumab (Ocrevus®), is approved for both relapsing forms and primary progressive MS (PPMS).^1,3

Comparison by route of administration

Subcutaneous injections:

• Interferon beta-1a (Rebif®)
• Interferon beta-1b (Betaseron®)
• Interferon beta-1b (Extavia®)
• Glatiramer acetate (Copaxone®, Glatopa®)
• Peginterferon beta-1a (Plegridy®)
• Ofatumumab (Kesimpta®)

Intramuscular injection:

•         Interferon beta-1a (Avonex®)

·         Peginterferon beta-1a (Plegridy®)

IV infusions:

• Alemtuzumab (Lemtrada®)
• Mitoxantrone (Novantrone®)
• Natalizumab (Tysabri®)
• Ocrelizumab (Ocrevus®)
• Ublituximab (Briumvi®)

Oral medications:

• Cladribine (Mavenclad®)
• Dimethyl fumarate (Tecfidera®)
• Diroximel fumarate (Vumerity®)
• Fingolimod (Gilenya®, Tascenso ODT™)
• Ozanimod (Zeposia®)
• Siponimod (Mayzent®)
• Teriflunomide (Aubagio®)
• Monomethyl Fumarate (Bafiertam®)
• Ponesimod (Ponvory®)

Comparison by common side effects

All medications can cause unwanted side effects. However, not all patients experience the same side effects. The side effects listed below are not all the possible side effects that these medications may cause. Individuals should talk to their doctor about what to expect and report any concerns to their doctor.^4-19

• Alemtuzumab (Lemtrada®) – Rash, headache, fever, inflammation of the nasal passages and throat, nausea, vomiting, fatigue, insomnia, red welts on skin, itching, thyroid gland disorders, joint pain, pain in arms or legs, back pain, mouth and throat pain, abdominal pain, diarrhea, sinus infection, tingling or prickling sensation, dizziness, flushing.
• Cladribine (Mavenclad®) - Upper respiratory tract infection, headache, lymphopenia
• Dimethyl fumarate (Tecfidera®) – Flushing, abdominal pain, diarrhea, nausea
• Diroximel fumarate (Vumerity®) – Flushing (developing red or hot skin), redness, itching, or rash, nausea and vomiting, diarrhea, stomach pain or indigestion
• Fingolimod (Gilenya®) – Headache, diarrhea, increased liver enzymes, cough, flu-like symptoms, sinus symptoms, infections, back pain, abdominal pain, and pain in the arms and legs
• Glatiramer acetate (Copaxone®) – Reactions at the injection site, lowered blood pressure, rash, difficulty breathing, and chest pain
• Interferon beta-1b (Extavia®) – Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
• Interferon beta-1a (Avonex®) – Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
• Interferon beta-1a (Rebif®) – Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
• Interferon beta-1b (Betaseron®) – Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
• Mitoxantrone (Novantrone®) – Nausea, hair loss, menstrual disorders (including amenorrhea), weakness or lack of energy
• Natalizumab (Tysabri®) – Headache, fatigue, joint pain, urinary tract infection, inflammation in the stomach, vaginal infection, depression, pain in arms or legs, abdominal discomfort, diarrhea, rash
• Ocrelizumab (Ocrevus®) – Infusion-related reactions
• Ozanimod (Zeposia®) – Upper respiratory infection, urinary tract infection, liver function changes, high blood pressure or changes in blood pressure when standing up (orthostatic hypotension), back pain
• Peginterferon beta-1a (Plegridy®) – Flu-like symptoms, headache, injection site reactions, blood count abnormalities, asthenia (feeling weak or tired), abdominal pain, diarrhea, nausea and vomiting, myalgia (muscle or joint pain)
• Siponimod (Mayzent®) – Headache, high blood pressure, increased liver enzymes
• Teriflunomide (Aubagio®) – Headache, diarrhea, nausea, hair loss, increased liver enzymes

Comparison by safety concerns

While rare, DMTs may cause serious side effects. Not everyone who takes these medications experiences serious side effects. Individuals should discuss all safety concerns with their doctor prior to beginning treatment with a DMT.^4-19

• Alemtuzumab (Lemtrada®) – Infusion-associated reactions and severe allergic reactions, rare viral disease (progressive multifocal leukoencephalopathy), development of secondary or new autoimmunity, including thyroid autoimmune disorders, increased risk of certain cancers, infections (including opportunistic such as herpes virus, human papilloma virus, fungal infections, listeria, and nocardiosis)
• Cladribine (Mavenclad®) – Increased risk of infections and malignancies, worsening of chronic infections such as HIV, hepatitis or TB, fetal harm.
• Dimethyl fumarate (Tecfidera®) – Severe allergic reaction, lowered white blood cell counts, liver injury, rare viral disease (progressive multifocal leukoencephalopathy), swelling (angioedema) in the face, tongue, throat, abdomen, hands, or feet
• Diroximel fumarate (Vumerity®) – Allergic reactions including welts and hives, PML (progressive multifocal leukoencephalopathy – a rare brain infection, shingles, decrease in white blood cell count, severe liver problems
• Fingolimod (Gilenya®) – Change in heart rhythm that may cause sudden death, increased risk of infections, rare viral disease (progressive multifocal leukoencephalopathy), increased fluid in the retina (macular edema), posterior reversible encephalopathy syndrome, respiratory effects, liver injury, risk of causing birth defects, increased blood pressure, basal cell carcinoma
• Glatiramer acetate ( Copaxone®) – Post-injection reaction (rapid heartbeat, anxiety, throat constriction)
• Interferon beta-1a (Avonex®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
• Interferon beta-1a (Rebif®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
• Interferon beta-1b (Betaseron®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
• Interferon beta-1b (Extavia®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
• Mitoxantrone (Novantrone®) – Congestive heart failure (can result in death) may occur either during or months to years after termination of therapy. Secondary acute myeloid leukemia, infection, lowered white blood cell counts, depression, vomiting, kidney failure
• Natalizumab (Tysabri®) – Rare viral disease (progressive multifocal leukoencephalopathy), severe allergic reactions, suppression of the immune system, increased risk of infections (including herpes simplex virus, meningitis), and liver injury
• Ocrelizumab (Ocrevus®) – Increased risk of infections, increased risk of certain cancers
• Ozanimod (Zeposia®) – Change in heart rhythm, increased risk of infections, liver damage, respiratory effects, macular edema, increased blood pressure
• Peginterferon beta-1a (Plegridy®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
• Siponimod (Mayzent®) – Macular edema, increased risk of infections, decrease in heart rate
• Teriflunomide (Aubagio®) – Liver injury, risk of causing birth defects, bone marrow effects, suppression of the immune system, increased risk of infections, peripheral neuropathy, skin conditions, increased blood pressure, respiratory effects, pancreatitis, lowered white blood cell counts

 

Invisible Symptoms of MS: Mood Swings

 

By Devin Garlit

Mood swings with MS

For those with MS, the frequent and almost instant changing of moods is a symptom that no doubt has a profound effect on many relationships. It is a terrible symptom that many don’t even realize is related to their MS. While these constant emotional changes can be hurtful to those we care about the most, they can also be horrifying for us. There are, however, some ways we can battle this invisible symptom.

What is a mood swing exactly?

So what are these mood swings I’m talking about? I think of it as a rapid change in thought and emotion that seems to come on instantly. I can go from super happy to super depressed in the blink of an eye! The worst part of this is that it can seem like there is no reason for it all. Other times, the smallest of things, a commercial, a song, even seeing a certain color, can trigger it. It’s not only a matter of being happy and then depressed, pretty much any set of emotions can pop up. Anger, of course, is one of the scarier and more destructive ones. It’s also not always a positive emotion to a negative one, in can be in reverse too. I’m sure I seem awful when I suddenly get angry about something, anything, and everything, but I probably look just as crazy when I go from very angry to super happy and loving the world. The emotions really are all over the place.

Living with emotional symptoms

Mood swings are a symptom that many people don’t realize can be attributed to MS. I’ve gotten the question many times from upset and frustrated people who finally start to wonder if their rapid and sometimes constant emotional changes are actually MS-related. It seems that this is another area where people don’t stop to think it could be their disease at work.

You can have MS lesions in the area that controls your emotions the same way you can have them in areas that affect your arms or legs. MS can bring about mood swings or even cause pseudobulbar affect (PBA), where you laugh or cry suddenly with seemingly no trigger at all.¹

What else can cause mood swings?

External factors can also lead to mood swings. Living with multiple sclerosis can cause a tremendous amount of pent up frustration, stress, anxiety, pain, and depression. It can be very hard to explain to others what it’s like going to bed each night not knowing if you will be able to walk in the morning. Not to mention the fact that many people lose their employment and even mobility due to the disease. Sometimes, no matter how happy a face you put on, there are still lingering concerns in the back of your mind, whether you realize it or not. If you don’t confront these thoughts, they can bubble to the surface at inappropriate times.

The impact on our relationships

Whether they are caused by the disease itself or the effects of having the disease, sudden mood swings can be a living hell. It’s bad enough that many of us are in pain much of the time, but sudden mood swings have the awful effect of causing pain in the ones we love. I know I personally have had many relationships ruined by the sudden outburst of emotion caused by my mood swings. The worst part of that for me, is that when I have these outbursts, I know that it’s not me. That’s not the real me that’s angry or sad. It just happens and I end up feeling tremendous regret at the ways I’ve acted or about the things I’ve said. You begin to feel like a bad person. I know that it makes people think of me as being a different person then I really am. That would take a toll on anyone.

Varying experiences

Like most multiple sclerosis symptoms, the level of severity can vary greatly from person to person, and even day to day for a particular person. I have days where I feel fine and notice no differences. I have others where I’m sure it seems I’m near bipolar. All of the normal MS triggers, like stress, temperature, humidity, and fatigue can play into the variance, frequency, and severity of my mood swings.

What can we do about it?

So what can we do? Well, first off, if you are experiencing mood swings, you should mention it to your neurologist. I also think it’s important to talk to your family and friends about it. You may not even realize that you are having mood swings. In my case, I talk with my wife about everything. That doesn’t always make it easier, but just being mindful that it’s an issue has seemed to help me (at least some of the time). It’s not using it as an excuse, it’s informing people. It’s ok to say “hey, I have this problem related to my MS.” It may sound like a convenient excuse to them, but that’s when you have the opportunity to share information with them and to show them that this is a real issue. It’s also important to consider talking to a mental health professional. They can help provide you with strategies on coping with your emotional issues. With everything on our plate, whether you have mood swings or not, just in general, it can be sound advice to talk to one about your MS.

One of many invisible symptoms

The one goal I had with this article was to bring up just one of the many invisible symptoms those of us with multiple sclerosis may deal with. I feel that symptoms like mood swings are not spoken about enough. There are many aspects of the disease that are not well understood by some neurologists, let alone the general public. So if anything, I hope to trigger conversation and the sharing of information about these issues. If we work together, as a community, to talk about and share our issues and ways to combat them, we can beat this disease!

Give Yourself Permission to Rest

 

 By Alene L. Brennan, RYT

Last Updated: January 28, 2026

 

I grew up in a house where we always had to stay "busy." Looking back, I guess it kept us out of trouble as kids. So, it served a purpose then. But, no I’m a 45-year-old woman living with MS and raising a toddler. I have to unlearn that “keep busy” mindset. If I don’t it will cost me my health.

Living with MS, rest is part of our healing plan. It’s not a luxury; it’s a necessity.

We tell ourselves the lie that we have to earn rest and that there's always more to be done.

What I've learned about rest

Rest isn't something you have to earn after being productive; it’s the very thing that helps you to be productive. Over the years, I’ve had to turn down the noise on thoughts like "but you haven't done enough today," so I could turn up the volume to the truth that reminded me, “your body needs you to rest right now, that’s the priority.”

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When your body demands rest, it's not being lazy – it's actively working on healing. My body has a pretty long to-do list when it comes to healing, too. Living with MS, my body is constantly working to reduce inflammation and ideally regulate its immune response.

I think all of this happens most effectively when resting.

So, I remind myself, that afternoon nap isn't a sign of giving up, it's giving my body what it needs to support healing.

Creating a Rest Routine

The planner inside of me very quickly turned this journey into an opportunity to create an official plan. I know that every day with MS is different, but it just felt good that I was putting a plan in place to increase my chances of actually resting more.

  

If you’re thinking about creating your rest routine, here are some things to consider.

• Create a restful environment in your home
• Set boundaries with others about your need for rest
• Learn to recognize early fatigue signals
• Have a rest plan for workdays
• Communicate your needs clearly with family

The Long Game

Think of rest as your long-term stamina strategy. Making rest a part of your regular routine can help you:

Have more stable energy throughout your day. Reduce the depth of energy crashes. Think more clearly. Experience more balanced mood. Save energy for what truly matters

Your Permission

Consider this your official permission slip to rest. To take that nap. To say no to that optional activity. To rest on the couch in the middle of the day. To listen to your body without guilt. Did you catch that last part “without guilt?” If you’re like me, you might need to read that line a couple times, so it really sinks in.

Your Plan

So, the next time you feel guilt creeping in about needing to rest, remember:

Rest is not a reward for being productive – it's a necessary part of living with MS. Listening to your body is an act of wisdom, not weakness. Every moment of rest is supporting your body's healing processes. You don't need to earn the right to take care of yourself.