From the FDA Drug Label
Dimethyl fumarate is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults. BETASERON is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.
The management of the first attack of multiple sclerosis (MS) is not explicitly stated in the provided drug labels. However, dimethyl fumarate and interferon beta-1b are indicated for the treatment of relapsing forms of MS, including clinically isolated syndrome, which may be considered as the first attack of MS.
- The initial dose of dimethyl fumarate is 120 mg twice a day, orally, for 7 days, followed by a maintenance dose of 240 mg twice a day, orally 1.
- Interferon beta-1b is administered via intramuscular (IM) injection, but the specific dosing regimen is not provided in the given drug label 2. It is essential to note that the provided information does not directly address the management of the first attack of MS, and the treatment should be guided by a healthcare professional.
From the Research
The management of a first multiple sclerosis attack typically begins with high-dose corticosteroids, usually methylprednisolone 1000mg IV daily for 3-5 days, sometimes followed by an oral prednisone taper, as this approach has been shown to reduce inflammation and shorten the duration of the acute attack 3. This initial treatment is crucial in managing the symptoms of the first attack. For severe attacks unresponsive to steroids, plasma exchange (5-7 exchanges over 2 weeks) may be considered as an alternative treatment option.
Following the acute attack, disease-modifying therapies (DMTs) should be initiated promptly to prevent future relapses and disability progression. The choice of DMT depends on several factors including disease severity, patient preferences, and risk factors. First-line options include:
- Injectable medications like interferon beta (Avonex, Rebif, Betaseron) or glatiramer acetate (Copaxone)
- Oral medications such as dimethyl fumarate (Tecfidera), teriflunomide (Aubagio), or fingolimod (Gilenya)
- Infusion therapies like natalizumab (Tysabri) or ocrelizumab (Ocrevus)
For highly active disease, higher efficacy agents like ocrelizumab, natalizumab, or fingolimod are often preferred initially 4. Treatment should be monitored with regular clinical assessments, MRI scans (typically annually), and laboratory monitoring specific to each medication. DMTs work by modulating the immune system to reduce the inflammatory attacks on myelin that characterize MS, thereby preventing new lesions, relapses, and accumulation of disability 5. Symptomatic management for residual symptoms like fatigue, spasticity, or bladder dysfunction should be addressed concurrently with appropriate medications and rehabilitation strategies. It is essential to weigh the benefits and risks of each treatment option, considering the potential for adverse events and the impact on the patient's quality of life 6.
Key considerations in the management of multiple sclerosis include:
- Early initiation of treatment to prevent long-term disability
- Regular monitoring of disease activity and treatment response
- Individualized treatment plans based on patient-specific factors
- Comprehensive management of symptoms and related conditions to optimize quality of life. The most recent and highest quality study 3 supports the use of early treatment with disease-modifying drugs to reduce disability worsening and relapses, and to delay the conversion to clinically definite MS.