Your MS Treatment Questions, Answered
We get it—whether you were diagnosed with multiple sclerosis (MS) this morning or 20 years ago, treatment options are daunting. New medications for this inflammatory autoimmune disease are added yearly to an already crowded list, and exactly how they work and what they do is confusing. It can be tough to keep up with everything treatment-related—and might leave you with more questions than answers. Whether you’re new to the chronic condition or have put your time in as an MS patient, we have info on MS therapies you’ll want to know about.
Where Do I Start With MS Treatments?
First things first. The best treatment for you depends on where you are in your MS journey. For instance, some treatments address early symptoms—these often include physical therapy, muscle relaxants, and meds for fatigue and anxiety. There are also treatments for MS flares, including short-term high-dose corticosteroids, plasma exchange (the plasma part of your blood cells is removed, mixed with protein, and returned to your body), and hormone-containing gels. And finally, disease-modifying therapies, or DMTs, help stop MS progression.
Which MS Treatment Is Right for Me?
Cliché but true, everyone experiences MS differently. The unique issues you face will dictate your optimal treatment path, says Daniel Ontaneda, M.D., a neurologist at Cleveland Clinic’s Mellen Center for Multiple Sclerosis in Ohio. Researchers have found that for many people, early DMT treatment can reduce symptoms of the disease as well as relapses. But you can still have issues with MS even while taking DMTs, and those need to be addressed to keep your condition from getting worse.
What Are DMTs?
While there’s no cure for MS, there are a lot of medications available to halt the disease in its tracks—about 20 and counting. Some of these drugs, known as disease-modifying therapies or DMTs, help reduce inflammation and nerve damage caused by MS. Available orally, as an injection, or by IV, DMTs can be highly effective at keeping patients in the relapsing-remitting phase of the condition, says Kathleen Costello, a nurse practitioner and adjunct assistant professor at the Johns Hopkins School of Medicine in Baltimore.
How Do I Choose a DMT?
Your doctor will talk with you about the options available. Which one you try first may be dictated, in part, by what your insurance will cover. If you're still feeling fuzzy on how various treatments work, reach out to organizations like the National MS Society. “We can help people understand factors they may want to consider when they speak to their health care provider, to help them navigate their way through,” says Costello, who is also the associate vice-president of Healthcare Access at NMSS.
How Do I Know if My DMT Is Working?
DMTs are not designed to help day-to-day symptoms so you cannot necessarily tell if they are working, however, the goal is to keep your MS under control. The clinical term for it is something of a no-brainer: “What we look for is called ‘no evidence of disease activity,’” says Dr. Ontaneda. In a nutshell, that means you stop having MS relapses or attacks, and there is no evidence of any new brain lesions on your MRI. “It’s a very achievable goal, and it’s what we strive for in all of our patients,” he says.
How Long Before I Feel Better?
Everyone is different—you might feel relief in a matter of weeks or maybe months. Your doctor will likely see you shortly after you’ve started a new treatment for MS to see how you’re responding, says Costello. The check-in usually involves an MRI, lab work, and a physical exam. “Most providers want to follow someone just starting on a therapy pretty closely,” she says. “Within six to nine months, you can have an indication of how someone is tolerating a drug or if the drug is having a sub-optimal response,” she says.
What if My Meds Aren’t Helping?
This is a real possibility—if you’ve been on a med for years, or even months, you may find that it isn’t working as well as it used to, or as well as another DMT might. In that case, you’ll want to discuss switching DMTs with your healthcare provider, Dr. Ontaneda says. Together, you can weigh the positive and negative aspects of your current treatment—including effectiveness, side effects, and changes in your MS itself—and determine if a switch in meds could be beneficial.
What Are the Side Effects of MS Treatments?
All meds have them, and DMTs for MS are no exception. They tend to be different than common neurological symptoms of the disease itself, making them easier to spot. Side effects include: Diarrhea, fever, hair thinning, high blood pressure, joint pain, liver changes, lowered white blood cells, and nausea. In rare cases, you can have a brain infection that could lead to bad outcomes (disability or death)—which is why it’s key to tell your healthcare provider if you experience any side effects.
How Long Will I Need to Take Meds?
Likely, indefinitely. Because MS is a chronic disease, to keep it from progressing, you’ll need to take a DMT to maintain. But you can switch to more tolerable, easier-to-take options as they become available or try another approach if your current drug isn’t preventing relapses or easing symptoms of MS. “DMTs have truly been life-changing for people,” says Costello. “Hopefully one day, we won’t have to worry about any of this, because we will have a cure.”
Treatment Types: Mayo Clinic. (2020). “Multiple Sclerosis.” mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274
Early Treatment Results: BMJ. (2016). “Disease Modifying Therapies for Relapsing Multiple Sclerosis.” pubmed.ncbi.nlm.nih.gov/27549763/
How DMTs Work: Patient-Centered Outcomes Research Institute. (2020). “Can People in Later Stages of MS Stop Taking Disease-Modifying Therapies? (The DISCO-MS Trial).” pcori.org/research-results/2015/can-people-later-stages-ms-stop-taking-disease-modifying-therapies-disco-ms
Navigators: National Multiple Sclerosis Society. (2020). “Ask an MS Navigator.” nationalmssociety.org/Resources-Support/Find-Support/Ask-an-MS-Navigator
DMT Efficacy: Frontiers in Neurology. (2018). “The Effect of Disease Modifying Therapies on Disability Progression in Multiple Sclerosis: A Systematic Overview of Meta-Analyses.” ncbi.nlm.nih.gov/pmc/articles/PMC6335290/
Side Effects: Multiple Sclerosis Association of America. (2020). “Long-Term Treatments for Multiple Sclerosis.” mymsaa.org/ms-information/treatments/long-term/