Multiple sclerosis (MS) affects each person differently. It can affect the brain or spinal cord and cause problems with vision, strength, balance, sensation, bladder function, memory, or thinking. Symptoms may begin suddenly or slowly, improve, return, or resemble another health problem.
A key feature of MS for many people is the relapse — a period of new or worsening symptoms — followed by a remission, when symptoms partly or fully improve. When relapses are an active part of a person's disease, it is called relapsing multiple sclerosis (RMS). This includes people whose symptoms recover between attacks, as well as people whose disability slowly builds over time but who still continue to have relapses.
This guide explores the vast treatment landscape for RMS and highlights five commonly prescribed disease-modifying therapies used for RMS: Kesimpta® (ofatumumab), Ocrevus® (ocrelizumab), Briumvi® (ublituximab-xiiy), Vumerity® (diroximel fumarate), and Tysabri® (natalizumab). Learning who may take them, how they work, how they are given, what research shows, and which side effects to watch for can help Black patients have clearer, more informed conversations about relapsing MS treatment with their healthcare teams.
While the accompanying guide goes into depth on specific treatments, you can find a more comprehensive list of treatment types, therapies, and options below.
Kesimpta® | Ocrevus® | Briumvi® | Vumerity® | Tysabri®
Black people are disproportionately affected by multiple sclerosis, often experiencing more severe symptoms, faster disease progression, and higher mortality rates at younger ages than white patients. Newer research has challenged the long-held belief that MS primarily affects white people, showing the disease is just as common among Black Americans—particularly Black women—than what has previously been understood.
Black patients with MS may also face delays in diagnosis or treatment, which can allow the disease to progress before appropriate care. There is no single reason for these differences, and race alone doesn’t determine how MS will affect someone. However, these findings make it especially important for Black people to discuss new or changing symptoms, treatment options, medication side effects, and ongoing MS care with their doctor.
The Relapsing Multiple Sclerosis (RMS) treatment landscape includes medications and several types of therapy, each with a different purpose. Learning about treatment choices can help patients take a more active role in managing relapsing MS care. The therapies and medications featured in this guide represent ways to treat different forms or stages of relapsing MS, and each has its own benefits, risks, testing needs, and side effects.
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.
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. Each DMT affects the immune system differently, but all are designed to reduce future MS disease activity.
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. 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.
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. They 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. Examples of rehabilitation and supportive therapies include physical therapy, occupational therapy, speech-language therapy, cognitive and other supportive therapies, such as nutrition and sexual health. The type of therapy used depends on the person’s symptoms and everyday physical limitations.
Some people use complementary therapy, such as 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.
As previously stated, DMTs 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:
Each DMT affects the immune system differently, but all are designed to reduce future MS disease activity.
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:
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.
The treatment options commonly used for relapsing MS can be divided into seven major disease-modifying medication classes. These classes include:
Short-term therapies help manage relapses, while other treatments relieve day-to-day symptoms, support movement and daily function, or address RMS-related complications. A person’s treatment plan may combine several therapies based on their symptoms, overall health, treatment goals, preferences, and response to treatment.
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.
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.
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.
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 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:
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:
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:
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:
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:
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.
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.
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.
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.
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.
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.
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.
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.
The Relapsing Multiple Sclerosis (RMS) treatment landscape includes medications and several types of therapy, each with a different purpose. Learning about treatment choices can help patients take a more active role in managing relapsing MS care. The therapies and medications featured in this guide represent ways to treat different forms or stages of relapsing MS, and each has its own benefits, risks, testing needs, and side effects.
A person’s daily life and preferences 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.
Short-term therapies help manage relapses, while other treatments relieve day-to-day symptoms, support movement and daily function, or address RMS related complications. A person’s treatment plan may combine several therapies based on their symptoms, overall health, treatment goals, preferences, and response to treatment.
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.
Medicines, vitamins, and supplements may interact with Multiple Sclerosis treatment.
These medicines work in different ways and are not right for everyone
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