What to Know About Infusion Treatments for MS

MS infusion therapy is one type of disease-modifying treatment delivered intravenously (IV). These medications carry risks, but they also allow freedom and flexibility in scheduling — and may better manage your multiple sclerosis (MS).

Many disease-modifying therapies (DMTs) are currently available for MS. These medications change activity in the immune system, lessen the frequency of MS episodes, and slow down the progression of the condition.

DMTs come in various forms, including oral medications, injections, and infusions.

Healthcare professionals deliver infusion therapies directly into a vein via an IV.

Each DMT currently available for MS has benefits and risks. Deciding which therapy is best for you may depend on your treatment goals, lifestyle, and insurance coverage. It’s a conversation you should have with your healthcare team.

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What is MS infusion therapy?

Infusion therapy involves delivering medication via an IV. It may help lower the number of new MS lesions in the brain or spinal cord, slow the progression of disability, and reduce the frequency of relapse.

According to a 2023 study of more than 150,000 adults with MS, a little over 8% of those who initiated a new DMT in 2020 used infusions.

Some people may find advantages to choosing an infusion therapy over other DMTs. For example, they only need to take infusion therapies every few months (or, in some cases, just once a year).

If you travel often, infusions may be preferable to calculating when to take an oral medication every day in different time zones — or getting insurance to approve a higher-than-usual amount of tablets so you can take them with you.

MS infusions also eliminate the storage hassles that can come with injectables, which often require refrigeration.

Infusion therapy can also be a good alternative if you find it difficult to remember to take a daily tablet.

Perhaps most importantly, some people may find that MS infusions manage their symptoms and disorder progression better than other forms of DMTs.

The Food and Drug Administration (FDA) has approved six infusion medications for the treatment of MS. These include:

• Briumvi (ublituximab-xiiy)
• Lemtrada (alemtuzumab)
• Ocrevus (ocrelizumab)
• Tyruko (natalizumab-sztn)
• Tysabri (natalizumab)
• mitoxantrone (currently available as generic formulation only)

Each of these MS infusions works slightly differently. Your doctor may advise which infusion therapy may be best for your situation.

Briumvi (ublituximab-xiiy)

Briumvi has FDA approval for the treatment of relapsing MS in adults. This includes relapsing-remitting MS and active secondary progressive MS.

This infusion reduces the number of B cells circulating in the blood. Experts believe that B cells may play a role in damaging the brain and spinal cord in MS.

Healthcare professionals deliver Briumvi as two infusions 2 weeks apart. Following this, they give the infusion every 24 weeks.

Lemtrada (alemtuzumab)

FDA has approved Lemtrada for use in relapsing forms of MS.

This drug targets a protein called CD52 found on T cells and B cells. Experts believe these kinds of cells play a role in the inflammatory processes of MS.

By targeting the CD52 protein, Lemtrada helps reduce the number of T and B cells circulating in the blood, lessening the effect of MS.

Healthcare professionals give it for 5 consecutive days, then 12 months later for 3 consecutive days.

Mitoxantrone

Mitoxantrone (a generic form of the medication previously known in the US under the brand name Novantrone) is a chemotherapy drug also used in the treatment of relapsing MS, secondary progressive MS, and worsening relapsing-remitting MS.

This infusion works by suppressing T and B cells that may cause damage to the myelin sheath — the insulating layer around nerves. MS can damage this layer.

Healthcare professionals administer mitoxantrone every 3 months.

Ocrevus (ocrelizumab)

Ocrevus is approved for use in both relapsing MS and primary progressive MS.

It targets CD20-positive B lymphocytes, a type of white blood cell that can contribute to nerve damage in MS.

Healthcare professionals initially give Ocrevus as two infusions 2 weeks apart, then every 6 months.

Tyruko (natalizumab-sztn) and Tysabri (natalizumab)

Both Tysabri and its biosimilar alternative, Tyruko, are FDA-approved for the treatment of relapsing forms of MS.

These drugs prevent immune cells from traveling from the bloodstream through the blood-brain barrier and potentially prevent damage to the brain and spinal cord.

Healthcare professionals administer these every 4 weeks.

What is the MS infusion process like?

You may receive MS infusions in a hospital, infusion center, or at a healthcare professional’s office. You may take some types of infusion therapy at home after training.

During infusion therapy, healthcare professionals place the IV tubing in a vein, typically in the hand or arm. This may cause some mild temporary discomfort, but it shouldn’t be painful. They then deliver medication via the IV into your bloodstream. The medication will then circulate throughout your body.

Total infusion time varies depending on the specific medication — you may have to stay at the site of your infusion anywhere from 2–8 hours.

Some infusion centers may provide blankets, Wi-Fi, and even snacks throughout your infusion. They may also warm the medication before infusing it to make you more comfortable.

Depending on the type of infusion medication you’re receiving, you may receive oral medications before your infusion to reduce any side effects.

Once the infusion treatment is complete, you may have to wait for a short time to check for any side effects.

To prepare for your MS infusion, try to drink lots of water in the 24 hours before your treatment. This will help make your veins easily accessible (no one likes to be poked more than once!).

Packing activities like a book, a movie downloaded onto your tablet, or other entertainment may help keep you busy during your infusion. You may also want to pack a sweater and cozy socks in case your infusion center is chilly, and perhaps your own pillow if you’re a napper.

If at any point during your treatment you feel uncomfortable or experience side effects, don’t be afraid to speak up and let your healthcare professional know.

What are the possible side effects of MS infusions?

MS infusions can cause a variety of side effects. Some of these are mild, and some can be life threatening. The most common side effects are called infusion reactions, and include symptoms such as:

• chills
• nausea
• headaches
• fever
• fatigue (low energy)
• skin changes, such as redness, rash, itching, or hives
• irritation of the throat
• tightening of the muscles of the airway
• insomnia
• pain
• dizziness
• rapid heart rate
• anaphylactic reaction

Also, each medication carries risks of other types of side effects. It’s important to discuss these with your doctor before starting treatment.

Briumvi (ublituximab-xiiy)

Briumvi may cause infusion reactions, upper respiratory infections, and other types of infections, including fungal, bacterial, and new or reactivated viral infections.

In studies, 56% of people with MS treated with Briumvi experienced infections, though only 5% were serious. You should not take this medication if you have an active infection.

Lemtrada (alemtuzumab)

Multiple serious side effects share a link with Lemtrada, and for this reason, the FDA recommends it only to people who haven’t responded to two or more other MS therapies.

Lemtrada can increase the risk of autoimmune conditions. In clinical studies, 36.8% of people with MS who received treatment with Lemtrada experienced autoimmune thyroid disorders.

Rarely, serious and life threatening strokes have also been reported within 3 days of receiving Lemtrada.

Also, Lemtrada may, in rare cases, cause an increased risk of cancer, including melanoma and thyroid cancer. In one review of studies, less than 2% of people who took Lemtrada developed cancer.

This therapy can also cause infusion reactions. In studies, 92% of people treated with Lemtrada experienced an infusion reaction, though only 3% were considered serious.

Mitoxantrone

The most common side effects of mitoxantrone include:

• nausea
• urinary tract infection (UTI)
• alopecia
• upper respiratory tract infections
• menstrual disorders, including amenorrhea (absence of menstrual period)

Although rare, people with MS who take mitoxantrone may experience cardiac changes — including congestive heart failure — during therapy or months or years following therapy. This can be potentially fatal.

Ocrevus (ocrelizumab)

The most common side effects of Ocrevus are infusion reactions.

Ocrevus may also cause infections, including respiratory tract infections and herpes.

A viral infection of the brain called progressive multifocal leukoencephalopathy (PML) has also been found in some people with MS — specifically, those who test positive for a common virus known as the JC virus — and who also take Ocrevus. This can cause severe disability or death.

For this reason, people with MS who are interested in taking this medication must first get tested for the JC virus.

Tyruko (natalizumab-sztn) and Tysabri (natalizumab)

The most common side effects of Tyruko and Tysabri include infusion reactions, as well as:

• UTI
• joint pain
• lung infection
• diarrhea
• vaginitis
• depression

Significant liver injury has also been reported from these infusions.

These infusions may also increase the risks of many types of infections. Among these are herpes simplex virus infections, which can lead to serious and life threatening illnesses like meningitis and encephalitis.

Like Ocrevus, Tyruko and Tysabri can cause PML in people who test positive for the JC virus.

Takeaway

Infusion therapies are just one type of disease-modifying treatment available for people living with MS.

Healthcare professionals deliver MS infusions via an IV. These infusions can help slow the progression of your condition and reduce lesions and frequency of relapse.

Six FDA-approved infusion therapies are available for people with MS, and each has benefits and potential side effects.

For some, infusions may be more effective in treating their MS symptoms and the course of their condition. They may also provide more convenience due to work and travel commitments or other scheduling reasons.

If you have questions about whether infusion therapy is right for you, speak with your doctor.