Infusion Therapy for Multiple Sclerosis

Multiple sclerosis (MS) is typically treated with medications that aim to calm flare-ups, manage symptoms, and slow disease progression. Infusion therapy is often used to deliver certain disease-modifying therapies (DMTs) to patients with MS. DMTs suppress specific actions by the immune system to slow its attack on nerve cells.

Read on to learn more about infusion therapy for MS. 

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.

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.

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). 

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, Tyruko (Natalizumab)

The common side effects of natalizumab are:

• Sore throat
• Urinary tract infection (UTI)
• Hives
• Headache
• Dizziness
• Nausea and vomiting
• Fever
• Joint and muscle stiffness

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)

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.