How to get the most out of treatment for SPMS

Multiple sclerosis (MS) is an autoimmune disorder where the immune system causes inflammation and damage in the central nervous system. Most people with MS are initially diagnosed with relapsing-remitting MS, which is characterized by episodes of worsening symptoms (relapses) followed by periods where symptoms improve (remissions).

Most people with RRMS will eventually develop secondary progressive multiple sclerosis (SPMS). This is a secondary phase of the disease where symptoms gradually become more severe, without remissions.

Are there medications that treat SPMS?

Treatment will depend on whether SPMS is relapsing or non-relapsing. Relapsing SPMS involves relapses similar to RRMS, but there is also a gradual progression of symptoms between relapses.

Non-relapsing SPMS does not involve relapses. Symptoms gradually worsen and disability gradually accumulates. Changes and symptoms can be difficult to identify without distinct relapses.

Disease-modifying therapies

Disease-modifying therapies (DMTs) are drugs that help reduce disease activity and slow the progression of MS. There are several DMTs available for the treatment of relapsing SPMS.

Treatment options for non-relapsing SPMS are limited. The first disease-modifying therapy for this category of SPMS is expected to become available in early 2026. This medication is a BTK inhibitor, a drug that blocks the activity of Bruton’s tyrosine kinase (BTK) enzyme. Blocking this enzyme helps regulate the activity of immune cells linked to MS inflammation and progression.

Other new and emerging therapies may be available through clinical trials. New and emerging therapies are an important topic to discuss with a healthcare team, especially if current treatment options are limited.

Medications to manage symptoms

In addition to DMTs, treatment often involves other medications to reduce and manage specific symptoms. While these medications do not affect the progression of SPMS, they can help improve a person’s quality of life while living with SPMS. This can include medications to help with pain, bladder control, fatigue, and mood disorders.

Like other parts of a treatment plan, this will vary from person to person.

How can I get the most from SPMS treatment?

The number one thing you can do to get the most out of treatment is to follow your treatment plan as closely as possible. This means taking your medication exactly as prescribed. It also means attending every scheduled appointment—regular monitoring through MRI scans and neurological exams are essential to managing SPMS.

Communication

Be honest with your healthcare team and be proactive about sharing information. This includes concerns, unmet treatment needs, cognitive changes, sleep, changes in symptoms, and any difficulty following a treatment plan.

Supportive therapies

SPMS can affect mobility, functioning, communication, and speech. Physical therapists, occupational therapists, and speech therapists can all play important roles. Cognitive rehabilitation may help if SPMS is affecting thinking and memory.

Primary care

Regular appointments with a primary care provider can help you manage other areas of your health and monitor for common health conditions, such as cardiovascular disease, diabetes, and osteoporosis.

Mental health

Talk to your healthcare provider about how you're coping emotionally. Depression and anxiety are common among people with MS. Counselors, mental health professionals, religious and spiritual advisors, and support groups can be valuable parts of a treatment plan.

Keep a symptom journal

Keeping a daily record of how you feel can help you identify gradual changes in symptoms and make it easier to share this information with your healthcare provider. A journal can also help you prepare for your appointments, keep track of what you want to discuss with your providers, and identify what you need from treatment.