Infusion Therapy for Multiple Sclerosis

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Multiple sclerosis (MS) is a progressive autoimmune disease that occurs when immune cells attack the protective coating (myelin sheath) of nerve cells in the brain and spinal cord. Though there is no cure for the disease, there are numerous treatment options available.

One treatment option is getting infusions of medications, which can calm flare-ups, manage symptoms, and slow disease progression. Read on to learn more about infusion therapy for MS. 

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What Is Infusion Therapy?

Infusion therapy is a treatment in which medication is sent directly into the bloodstream intravenously (IV, through a vein) using a central venous catheter (central line).

A central line is much longer than a typical IV. It is placed in a major vein near the heart or just inside the heart. Central lines can be used if a person needs multiple IV treatments.

Infusions are given in place of certain oral medications since traveling through the digestive system can make the drugs less effective. The lines are also used when medication needs to be administered at a specific pace.

Medications in MS Infusion Treatment

Infusion therapy is often used to deliver certain disease-modifying therapies (DMTs) to patients with MS. DMTs suppress certain actions by the immune system and slow the damage to the nerves and myelin.

Before, During, and After Treatment

IV infusion therapy is usually done in your doctor’s office or in the hospital. Before starting your infusion, you will be prepped for the IV insertion. You will also receive medication such as an antihistamine, corticosteroid, and a fever reducer to prevent infusion-related side effects.

Since IV infusions can take four or more hours to complete, you may be offered some comfort objects such as blankets and pillows. Once the initial setup is complete and the IV is properly hooked up, you will begin treatment. You can read or watch TV to pass the time.

Once the treatment is over, the IV will be removed and you will be monitored for up to one hour for infusion reactions. If none occurs, you will be able to go home and return to your usual activities.

Infusion-Related Reactions

If you experience signs or symptoms of an infusion-related reaction, such as hives, a rash, coughing or wheezing, unordinary tiredness, headache, nausea, redness in the face, or shortness of breath, in the first 24 hours after your infusion, call your doctor immediately. While some reactions are not medical emergencies, others could be.

Timing of IV Appointments

The timing of IV appointments will vary greatly depending on the medication that you are taking. For example, one medication may take up to four hours while another might only take one to two hours.

The length of your infusion will be based on the medication that you are taking. Other factors related to the specifics of your MS will also be taken into account when determining the duration of your infusion treatments.

Disease-Modifying Drugs

There are several DMTs that are given intravenously, including:

  • Tysabri (natalizumab): Tysabri is a DMT that hinders the immune cells’ ability to cross into the brain and spinal cord, where they damage the nerves. It is used to treat clinically isolated syndrome (CIS, a first episode of neurological symptoms), relapsing-remitting MS (worsening symptoms followed by periods of stability), and active secondary progressive MS (a second phase of MS). 
  • Lemtrada (alemtuzumab): Lemtrada is a DMT that is reserved for people with MS who have not yet found relief from their symptoms using two or more other MS treatments. It works by attaching itself to the immune cells that attack the myelin sheath and killing them so that they can no longer damage nerves. The medication can treat relapsing-remitting MS and active secondary progressive MS.
  • Novantrone (mitoxantrone): Novantrone is a type of medication that is designed to kill cells (antineoplastic). Although antineoplastics are typically used to treat cancer, Novantrone is approved by the Food and Drug Administration (FDA) to treat secondary progressive MS, progressive-relapsing MS (progressive worsening of MS), and relapsing-remitting MS because of its ability to suppress the nerve-damaging action of immune cells.
  • Ocrevus (ocrelizumab): Ocrevus targets specific immune cells that attack the myelin and cause damage in people with MS. It is used to treat relapsing forms of MS and primary-progressive MS (worsening of neurological function). 

Which Infusion Medication Is Right for Me?

You will not get to choose which infusion medication you receive. Your provider will discuss the options with you and determine which one will be the best choice for your specific case.

Possible Side Effects

As with most medical treatments, infusions for MS do come with a risk for side effects. Each DMT that is used for MS has its own possible adverse effects. Common infusion side effects include:

  • Bleeding or bruising at the injection site
  • Reddening and warming of the skin (flushing)
  • Chills
  • Nausea
  • An allergic reaction that presents with hives, fever, a rash, or scaly patches on the skin

Tysabri (Natalizumab)

The common side effects of Tysabri are:

Serious Side Effects of Tysarbi

There are also some serious side effects that can occur with Tysabri, including:

Lemtrada (Alemtuzumab)

Side effects of Lemtrada can be mild or severe. Common symptoms of Lemtrada include:

  • Headache
  • Rash
  • Nausea
  • Flushing
  • Hives
  • Insomnia (sleep problems)
  • Itchy skin
  • Fever

More serious side effects can also occur with people taking Lemtrada, including:

  • Low blood platelet counts
  • Respiratory infections
  • Secondary autoimmune diseases 
  • Thyroid disease
  • Cancer
  • Lymphoma (cancer of the lymphatic system, the body's disease-fighting network)
  • Blood disorders
  • Organ failure

Novantrone (Mitoxantrone)

Most side effects of Novantrone are mild and include:

  • Nausea and/or vomiting
  • Diarrhea or constipation
  • Heartburn
  • Loss of appetite
  • Sores in the mouth or on the tongue
  • Thinning hair or hair loss
  • Missed or irregular menstrual periods
  • Extreme fatigue
  • Headache
  • Back pain
  • Weakness

In some cases, Novantrone can cause serious side effects that require medical attention, such as:

  • Bleeding or bruising that is unusual in nature
  • Red or purple dots on the skin
  • Pale or yellowing of the skin
  • Hives
  • Itching
  • Rash
  • Difficulty swallowing
  • Shortness of breath
  • Dizziness or fainting
  • Seizures

Ocrevus (Ocrelizumab)

Ocrevus can have common and more serious side effects. Common side effects can include:

  • Itchy skin with a rash or hives
  • Tiredness
  • Coughing or wheezing and trouble breathing
  • Throat pain or irritation
  • Fever
  • Facial redness
  • Nausea
  • Headache
  • Throat swelling
  • Dizziness
  • Shortness of breath
  • Fatigue
  • An increased heartbeat

More serious adverse effects of Ocrevus can include:

  • Upper respiratory tract infections
  • Progressive multifocal leukoencephalopathy (a rare brain infection)
  • Hepatitis B reactivation
  • A weakened immune system
  • Lowered amounts of antibodies (specialized molecules designed to recognize and rid the body of specific pathogens)

When to Call Your Doctor

It can be hard to determine how a medication will affect you until you take it. If you have any mild or common side effects that are concerning you, be sure to talk to your doctor.

If you notice any worsening symptoms or are experiencing serious adverse effects, you may need to seek immediate medical care. Although rare, some serious side effects can be fatal.

If you are not sure if you having a serious reaction to an infusion medication, go to the emergency room to be checked out.

Summary

Infusion therapy can be an effective treatment for many people with MS. However, not all people will benefit from all infusion medications. You and your healthcare team may have to try several to find out which one works best for you.

A Word From Verywell

Advancements are being made in MS treatments and medications every day. Many medications that are being used are very effective at managing symptoms, reducing flare-ups, and slowing disease progression. Your doctor can discuss infusion therapy with you and determine if it is an option in your case.

Frequently Asked Questions

  • Are infusions safe?

    Infusions for MS are generally considered safe but there is always a risk that you may experience an infusion reaction or side effects. Talk to your healthcare provider about your concerns. A doctor will help you make an informed decision about your care.

  • Are infusions painful?

    Getting a needle inserted for a central line before you start the infusion might be uncomfortable or painful, however, the infusion itself is not painful. Once the medication is being administered, it’s unlikely that you will experience any discomfort or pain.

  • Can you eat before an infusion?

    Your care team will likely encourage you to eat before an infusion. Foods that are high in nutrients will be good for your body while you undergo infusion therapy. No specific precautions, dietary or otherwise, need to be taken before an MS infusion treatment session.

  • How do you feel after an infusion?

    It can be hard to determine how you will feel following an infusion. You may feel light-headed or fatigued, but since everyone reacts differently to medications, it’s important that you bring someone with you to your first infusion. They can provide support and give you a ride home when your treatment is done.

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12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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