Multiple Sclerosis Centers of Excellence
Multiple Sclerosis Medications: Decisions and Discussions
Kathy Tortorice, PharmD, BCPS -- VA Pharmacy Benefits Management
Receiving a diagnosis of MS can overcome you with fears about the disease, the medications, and what all of this will mean for your future. Suddenly you are faced with a multitude of decisions to make. Trying to organize your thoughts and concerns so that you can discuss them with your healthcare provider and your support system is important. There isn’t a list of the “right” questions for everyone. You may have different questions or concerns than someone else. Organizing your questions will help provide a logical path towards choosing the right options for you.
Many types of medications are used to treat MS and its symptoms. Most people will need to decide about taking a disease modifying medication (DMT) to control their MS. These medications improve the course of the disease by decreasing the number of relapses, slowing the progression of disability, and/or decreasing the number of active lesions in the brain and spinal cord seen on MRI. Unfortunately, like most medications, all MS DMTs carry some risks.
It’s important to know that each person’s body or disease can respond to these medications differently. Some people get certain side effects when other people don’t. One person’s MS may be controlled by one medication, however the same medication may not control someone else’s MS. So, the medication that is the best option for one person may not be the best option for another.
When thinking about DMTs (or any medication you may need) the risk vs. benefit of taking the medication needs to be considered. Asking questions based on the potential risks and benefits of a DMT allows you to consider the effects of a medication on your lifestyle, as well as on the disease course and symptoms. Some people are willing to accept a high level of risk in taking a DMT that has a high potential benefit. Other people may prefer to keep the risk low. Additionally, the severity of MS or the type of MS (primary progressive, secondary progressive, or relapsing) can affect whether a DMT will work for you and, if so, which DMT you choose. A higher level of risk and more monitoring may be worthwhile with severe or earlier MS as this is likely to more quickly and effectively control your MS. For others with a mild form of MS, a DMT with a high level of risk may not be likely to offer more benefit or be necessary to control the disease.
All MS DMTs affect your body’s immune system, so some can make you more likely to develop certain infections. Others can be more dangerous when taken in combination with other medications. Some are not safe to use in people with other health issues such as heart conditions, breathing problems, or other chronic diseases. None of the MS medications are specifically approved by the US Food and Drug Administration for women who are pregnant, plan to become pregnant, or who are breastfeeding, but some are safer than others. It is important for women to discuss their plans for pregnancy with their provider so that they can decide the best and safest plan for managing their MS through their pregnancy and beyond. Men should have this same discussion with their provider since some DMTs can cause concerns if a partner becomes pregnant.
Having chosen an MS DMT to start with, remember that people and their MS change over time. A medication that works well for you now may not work as well in the future, and you may need to change to a different medication. Fortunately, there are many medications to choose from, and they are coming up with new ones all the time. The first MS DMT, Betaseron, became available in 1993. Betaseron is given by injection. Several other injectable DMTs became available in the 1990s. Providers and people with MS now have over 25 years of experience with these injectable medications and they have proven very safe and quite effective. More recently, oral (pills and capsules), and infusible (given intravenously) MS medications have become available, and recently, ofatumumab, another injectable DMT, was added to the choice of DMTs. These newer DMTs are generally more effective than the older DMTs but most also come with more risk, and we don’t have as much experience with them.
In addition to considering risk and benefit, remember that you need to choose a medication you think you can take as prescribed. Taking your medication as prescribed is key to its effectiveness. If you can’t stand shots or hate needles, then one of the oral agents may be the best choice for you. If you want a DMT that’s had more years of demonstrated safety and efficacy, one of the injectables might be a better choice. If you have trouble remembering to take your medications, or don’t like to have to take something every day or a few times a week, you might do better with an infusible medication. Also, keep in mind that many of the DMTs need blood tests to check for safety concerns.
Discuss your DMT options with your provider. Make a list of questions that will help you make a choice you are comfortable with and can stick with. This will give you the best likelihood of treatment success.
Here are some suggested discussion points and questions:
- Which medication(s) can be used to treat your MS or help manage your symptoms?
- How effective are these medications? What are their benefits?
- What types of side effects are common with these medications? What should you do if you develop side effects?
- Which type of medication would you prefer, a self-injected shot, pills, or traveling to a clinic for an infusion? How do you feel about follow-up visits and labs for monitoring?
- If you have other medical problems, which medications will affect your ability to take your other medication(s) safely? Which MS medications are safest for you to take?
- If you are hoping to get pregnant, how should this affect your treatment choice?
