How to Choose the Right RRMS Treatment for Youby Lara DeSanto Health Writer
From daily pills to twice-yearly infusions, there are tons of effective options available for treating relapsing-remitting multiple sclerosis (RRMS), the most common type of MS. And while it’s good news that there are so many effective treatments these days, choosing one can be pretty overwhelming to navigate: How do you pick the right medication for you? We spoke to the experts about the pros and cons of each major medication category, plus how to best work with your doctor to come up with a treatment plan that fits your unique needs.
How Do Medications Treat RRMS?
More than a dozen RRMS meds are approved by the U.S. Food and Drug Administration (FDA). “The best method to prevent MS flares in RRMS is to work with your MS specialist to ensure you are on an appropriate disease-modifying regimen,” explains Jacqueline F. Rosenthal, M.D., a neurologist at the Andrew C. Carlos Multiple Sclerosis Institute in Atlanta, GA. “[These therapies] work to reduce relapses, MRI changes, and/or progression by helping the immune system to ‘behave’ more appropriately so it's no longer attacking the myelin of the optic nerves, brain, and/or spinal cord.”
Injectable Medications: The Basics
When choosing between RRMS medication options, it helps to break them down into categories by route of administration. First up is injectable meds—basically, shots you give yourself at home. Many are called beta interferon-based drugs, explains Thomas J. Shoemaker, M.D., a neurologist at Rush University Medical Group in Chicago, IL, which are some of the oldest MS drugs on the market. All injectable medications work by impacting the immune system to help reduce inflammation. “They’re very safe and modestly effective,” Dr. Shoemaker says. Injectable treatments include Avonex (interferon beta-1a), Betaseron (interferon beta-1b), Copaxone (glatiramer acetate), and others, he says.
Injectable Medications: Other Considerations
Depending on which specific injectable drug you’re taking, you may need to give yourself a shot daily, a few times a week, weekly, or every two weeks, says the National MS Society. There are pros and cons to this—for one, it might be nice not to have to go into an infusion center every time you need an MS treatment, says Dr. Shoemaker. That said, you do have to give yourself a shot on the regular, which for some is unpleasant. The most common side effects include flu-like symptoms and swelling, per the National MS Society.
Oral Pill Medications: The Basics
Next up are the oral medications—yep, good old-fashioned pills that you take daily or twice daily, which may feel a bit more comfortable than injectables for the needle-averse folks out there. These drugs include some of the newer medications for RRMS, says Dr. Shoemaker, including Aubagio (teriflunomide), Mayzent (siponimod), and Tecfidera (dimethyl fumarate). “By and large, these pills work better than the self-injections,” says Dr. Shoemaker. However, potential side effects may come with increased effectiveness, she adds.
Oral Pill Medications: Other Considerations
A more-effective pill over a less-effective needle may seem like a no-brainer—but not so fast. “Because all of our MS therapies target the immune system, the more effective they are, the more possible safety issues they have,” says Dr. Shoemaker. That means an increased risk of things like infection or gastrointestinal issues including nausea and diarrhea. Additionally, some oral treatments require that you get regular blood tests to monitor things like your white blood cell count, per the Mayo Clinic.
IV Infusions: The Basics
The third major category of RRMS medications is intravenous (IV) infusions, which you receive at an infusion center every one to six months, depending on the specific drug, says the National MS Society. Some of the approved infusion drugs include Lemtrada (alemtuzumab), Ocrevus (ocrelizumab), and Tysabri (natalizumab). “Probably the most impactful medication is ocrelizumab [Ocrevus], which was approved in 2017 and is one of the most commonly prescribed medications now,” says Dr. Shoemaker. “Once you’re on it, you only get it every six months, which is really helpful for patients. It has high efficacy, good tolerability, and is relatively safe.”
IV Infusions: Other Considerations
While infusion treatments are appealing because they are highly effective and don’t require a daily shot or pill, they can come with greater potential risks. Some of the most common side effects are called “infusion reactions” that occur at the time of infusion, such as itchy skin, flushing, or fever, per the National MS Society. And again, because these drugs work by impacting the immune system, they can raise your risk of infections. Some of the infusion drugs come with other serious risks, says Dr. Shoemaker, such as autoimmune conditions or, rarely, brain infection.
Treatment Goals Help Determine the Right Drug for You
So, how does your doctor decide which medication to prescribe? Much of the decision comes down to your personal preferences. “It is important to discuss treatment goals with your MS neurologist to ensure you are on the most appropriate therapy,” says Dr. Rosenthal. For example, you may prefer a daily pill to a self-injection, or you may prioritize minimizing potential side effects, says Dr. Shoemaker. Additionally, women of reproductive age should understand how certain drugs may impact fertility. Your doctor will also consider your specific disease and risk factors to help determine the best treatment plan, Dr. Shoemaker says.
Medications Are Continuously Improving
While having so many RRMS medication options can be daunting, the good news is that as more drugs get FDA-approved, the more improvements researchers have been able to make to them. “A fair number of the newer medications are really just fine-tuning older medications or finding novel ways to deliver them,” explains Dr. Shoemaker. That might mean there is a newer version of an older drug that has fewer side effects, or a new version of an effective drug that you can take less frequently. Communicating your treatment preferences with your doctor can help you work together to find the best choice.
Knowledge Is Power
No matter how your RRMS treatment plan shakes out, it’s wise to consider all your options and be proactive about working with your doctor, says Dr. Shoemaker. “Having an understanding of your medication options can help you feel empowered to make the right decision and become an active participant in the treatment process.” And remember, says Dr. Rosenthal: It’s important to take your medication as directed, and keep your doc in the loop. “If there’s any issue with tolerating your medication, discuss your concerns with your MS neurologist to determine a plan that may be better suited.”