9 Reasons You Might Swap Your MS Meds
There are a variety of reasons why people switch their medications for multiple sclerosis (MS). A common one? Not every medication is ideal for every person—or, one drug may work well for you for a while, then stop being effective as your disease progresses and your symptoms change. Side effects and pregnancy can also drive a switch. The most important thing is to work with your doctor to navigate any new treatment regimen. Here, experts common reasons people switch up their medications, and how to do it safely.
1. Uncontrolled MS Symptoms
“When someone continues to have new lesions on an MRI, or continues to have relapses, the provider should discuss switching DMTs,” a.k.a., disease-modifying therapies, says Julie Fiol, M.S.W., director of MS Information and Resources for the National MS Society. Since DMTs don’t start working immediately, your doctor will want you to stay on your original medication for a while before switching to a new one. Your doctor will also make sure you’re taking your medicine as prescribed, since user error can be a culprit for why meds are not working in the first place.
2. Intolerable Side Effects
Side effects including flu-like symptoms, stomach pain, nausea, diarrhea, or difficulty breathing can make certain medications tough to tolerate for some folks (because people can react to them differently). Also, “there are other effects that someone might not feel but could be noticed on a medical test, like elevated liver enzymes or a problem with their vision, that can make remaining on that DMT unsafe,” adds Fiol. “Most often, DMT side effects are transient and improve with time—but sometimes they don’t.” If your side effects don’t improve, talk to your doctor about making a change.
3. Where and When a Drug Is Given
“The frequency of DMT administration varies—some are administered as frequently as twice daily and others as infrequently as yearly,” says Fiol. There are trade-offs: The more frequently administered therapies tend to be taken at home, while those that are administered less frequently are given at a clinic or infusion center. Someone might have trouble remembering to take one of their twice-daily doses, rendering the medication less effective since it isn't being taken as prescribed. This person might prefer a treatment that is administered in a clinic setting to make it easier to remember.
4. The Delivery Method
“As a patient’s lifestyle changes, they may find that a different route of administration is ideal for them. The available options include oral, self-injections, and infusions,” explains Kalina Sanders, M.D., a board-certified neurologist at Baptist Health, in Jacksonville Beach, FL, who specializes in multiple sclerosis and spasticity management. Depending on your circumstances and unique preferences, you may find it easier to adhere to one route of administration versus another.
5. Increased Infection Risk
Many DMTs can increase your risk of developing an infection. “If someone develops an infection while on a DMT, their provider might suggest a change to a DMT without that risk,” explains Fiol. According to the National Institutes of Health, a person’s age, gender, co-morbidities, prior treatment (such as chemotherapy) and other factors like body mass index (BMI) can affect infection risk. Adds Fiol, “Some DMTs alter the immune system and can impair someone’s ability to fight infection,” so a doctor should monitor you closely (regularly checking your white blood cell count is one way) while you’re on one.
6. Risk for Other Conditions
“Some of the DMTs can increase the risk of developing certain types of cancer,” says Fiol. (This can include a slightly elevated risk of breast cancer in women, according to research.) “People can also be diagnosed with cancer in addition to having MS. If that happens, the provider might switch to a DMT that is safer to use with the cancer medications the person needs.” Some medications don’t work well together, so if the cancer meds and the DMT meds are reactive, your doctor might suggest switching out your MS meds.
7. You’re Pregnant
“Most DMTs are not used during pregnancy,” says Dr. Sanders. This is due to the potential risk to fetal development, per recent research. “However, there are instances where there should be a significant delay in attempting to conceive after stopping a medication.” During this interim, Dr. Sanders might switch a patient to Copaxone (glatiramer acetate), an immunomodulator, which she considers to be relatively safe during pregnancy. According to the National MS Society, changes that take place in a woman’s body during pregnancy are believed to contribute to less inflammation, less MS activity, and fewer relapses.
8. Insurance Plan Changes
Oftentimes, a swap is driven by insurance and/or financial issues. “There are frequent insurance formulary changes, and medications will be excluded from the plan,” explains Dr. Sanders. “If we can’t get the insurance to approve the medication, a patient may choose to switch.” In this case, the patient should work closely with their doctor to find a similar DMT that works for their lifestyle. Foils adds that it’s common for “a person [to be] stable on a drug for months to years, and then their insurance plan, which hasn’t changed, decides it will no longer cover that drug.”
9. Timing Matters
“There might be specific timing instructions to follow, like when to stop one DMT and start the new one. Keep to these instructions and ask questions if something is unclear,” advises Fiol. Many DMTs require blood tests be completed before starting. Additionally, many providers request a new baseline MRI at the time of switching medications. Make sure you have the lab orders you need. Use your calendar to schedule reminders for these tests or, better yet, set up the appointments for these tests now so you don’t forget. Ask questions of your provider if anything isn’t clear.
DMTs and Infection Risk: National Center for Biotechnology Information, U.S. National Library of Medicine. (2020.) “Disease Modifying Therapies and Infection Risks in Multiple Sclerosis—a decision-making conundrum.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327337/
DMTs and Pregnancy: National Center for Biotechnology Information, U.S. National Library of Medicine. (2020). “Pregnancy-related Issues in Women with Multiple Sclerosis: An Evidence-based Review with Practical Recommendations.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034025/
DMTs and Reproduction: The National Multiple Sclerosis Society. “Pregnancy and Reproductive Issues.” https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Womens-Health/Pregnancy