Choosing A Treatment or Medication
After a diagnosis, the next step would be discussing with your doctor about beginning
treatment. You may be given several choices in medication to consider for your specific
type of multiple sclerosis (MS). If this is the case, then you will want to compare them
all carefully so you and your doctor can make informed choice together. A decision
does not have to be made at once but it does need to happen soon.|
Given a choice of treatment options, your doctor should then be able to answer your questions
about the pro's and con's of each and which is best suited for you. Be sure that your questions
are answered until you are satisfied, if not, then keep asking till you are. If you begin a
treatment and those questions are not answered, then you may not have a good outcome, such as
those who are scared of needles that choose an injectable treatment plan.
If you were diagnosed with relapsing-remitting multiple sclerosis (RRMS) seven years ago,
you had just seven disease-modifying treatments (DMTs) to consider. With the expected
approval from the U.S. Food and Drug Administration (FDA) of ocrelizumab (Ocrevus) in late
spring or early summer 2017, those with MS will have as many as 15 treatment options. In a
short time, there have been significant advances in both effectiveness and convenience of
the treatments that are available.
In the U.S., there are currently 14 DMTs that have been approved by the FDA for RRMS. Each
drug offers a different combination of benefits and risks. Seven years ago, with the choice of
treatments being more limited, the decision on which to choose treatment was probably less
difficult. Whether you are looking for a basic information on DMTs, having to make a choice
of treatments, or even whether to start treatment, this can be a difficult decision to make.
The decision to start treatment with a DMT is a personal choice. You have to weigh a great
many options for each of the medications available and think about your own views, preferences
and attitude toward risk. Where you are in life and current circumstances may have a big
impact on deciding which treatment is best for you.
With all these options, choosing a treatment basically comes down to three factors: efficacy,
risk, and convenience. Many of the older treatments may seem less effective, but they have a
well-defined and longer term safety history. Many of the newer treatments appear more effective
but come with a history of more safety issues. This can cause a bit of a struggle when trying to
decide. Do you want more safety or more efficacy?
The final decision to start on a DMT and which specific medication should be made between
you and your doctor. Your doctor can advise on which treatments might be right for you
and your specific type of MS. Being informed about the available options and what's important
to you, will help you make an informed choice.
Consider What's Important To You
It's your choice on how much you want to be involved in choosing your treatment. You might want
your neurologist to make the decision or you may want them to give you the options for you to
decide on your own.
Starting any treatment is a longterm commitment, so it's important that you have as much
information as you need to make your decision. Your doctor will have knowledge and experience
in managing MS, but it's your life and you know what matters to you. Combining your preferences
and desires with your doctors experience can help you make a choice that's the best blend between
the effectiveness of the drug and how well it suits your circumstances.
When choosing a treatment, it's important to think about:
||What is important to you?
||What do you want to achieve by taking treatment?
||Do you usually make decisions on your own or do you
rely on the advice from others?
||Are you a risk taker or more cautious?
||You might like to think about your options alone or you
may like to consult others.
Your Circumstances And Commitments
Starting any kind of treatment is a commitment. No matter what, you need to take it exactly
as it's prescribed for you. You can't have an attitude that "I feel good today, I can skip a
day", because all that will do is to turn around and bite you on the back side. This is a battle
within your body and if you want a chance of winning, then you need to stay on top of everything
that can either help or hurt you.
It's also important to know, with some of the treatments there are additional commitments you
might need to make. Some require you to go to your doctors office, infusion center, or hospital
for treatment, some have regular blood tests, and others might need to be stored in a particular
way (such as refrigeration).
Starting treatment is likely to have some impact on your life. You know your circumstances,
your commitments and how much flexibility you have in your schedule. Listed below are a few of
topics you might think about when you consider your treatment options.
||Family: Are you considering starting a family
soon? For women, none of the medications are recommended for use during
pregnancy, and this may have an impact on when you start treatment.
||Work: If you travel a lot with work, work unusual
hours or on shifts, what impact might that have? Could you take your doses
at the correct times? How easy would it be for you to attend regular check-ups?
You may not have told your employer about your MS diagnosis, especially if your
MS is not having an impact on your work. If you need time off for treatment
or tests, you might need to think about how you can arrange your appointments,
or find a way you can have the necessary time off without raising concern if
you're not yet ready to tell people.
||Vacations: Do you like distant or extended vacations?
Or are you planning on going traveling for a long period? There are some drugs
that might be more convenient for your lifestyle, but you might need to make some
arrangements with your doctor to ensure you can take your medications with you and
continue treatment uninterrupted. Taking doses at the right time and spacing them
appropriately can also be an added challenge when you are crossing time zones.
||Health: Do you have any other health conditions? It's
important to let all your doctors know about any other conditions that you may have. If
you do have other health issues or take certain drugs for that condition, then some
of the current MS medications might conflict with them. Additional tests will probably
be necessary as well. You may also want to consider whether any potential side effect
of the MS medications could aggravate your non-MS pre-existing condition.
||Storage and Supply: Since some of the drugs need to be
refridgerated, you might need to consider if this is possible for you. Do you have
enough space at home or a secure place at work to store your medication? If you have
small children in the house, will your medications in the refrigerator be out of
The Pros And Cons Of Treatment
Weighing up the pros and cons of your treatment options should be part of your discussion with
your doctor. Everyone will have very different ideas of what they consider to be pros or cons.
There are a number of different benefits, risks and potential side effects that are associated
with each of the medications, you should know about all of them so you can consider which factors
are your specific pros or cons. One of the biggest is usually how the medication it taken (oral,
injection, or infusion).
Sometimes there has to be a "trade off" in order to receive the benefits of a particular treatment.
You might need to be willing to accept the possibility of particular risks or the inconvenience of
going for regular treatment or tests.
The Benefits Of Beginning Treatment
The benefits would be those things that you would consider to be an advantage or what you hope to
gain from taking the medication. The main benefit associated with all of the medications is their
ability to reduce the number and severity of relapses. The positive effect of your treatment may not
be immediately obvious, typically it's not, as it may take up to six months for the drug to become
fully effective. It can be difficult to know how many relapses you would have had without treatment
compared with how you are on treatment. However, you should notice a difference in your relapses over
the longer term once your treatments begin.
The Side Effects And Risks
Side effects are the unwanted symptoms caused by a medical treatment and they can happen with any
medication, whether it's prescription or over-the-counter. Any medication will most likely cause some
type of side effect and it's typically different for each person. Any of the listed side effects may occur,
but it's important to remember that just because it's listed as a side effect doesn't mean that it will
occur to you.
Most side effects are usually reversible once a medication is stopped. Generally, most of the side effects
of the MS medications are considered to be relatively mild and manageable for those that experience them,
and they often ease over time as the body adapts to the presence of the drug. However, for some people
side effects can be inconvenient and intrusive enough to change or stop treatment.
It's important to know that there are some serious side effects and risks associated with all the DMTs.
The risk of these serious side effects is low, but if they do occur they become significant events. A
few of these events or conditions can be life changing and they might not be reversible, even if you
stop taking the medication. The risk of these happening should therefore be considered carefully in
your decision. Some DMTs are considered to be more effective at reducing relapses, but as a result
may have more marked, and potentially serious, side effects and risks associated with them compared
to some of the other DMTs.
Now although you will have regular monitoring, more frequent for the high risk medications, so your doctor
can intervene quickly should problems arise, you may still feel that the risk is too high. One the other
hand, you may feel that the benefits of these treatments outweigh the risks. It's all comes down to a
matter of personal choice by you.
The Goal Of Your Treatment
DMTs work with different parts of the immune system to prevent the inflammation caused by MS. This
helps reduce the number and severity of relapses. Inflammation in MS can also lead to permanent damage
to the nerves in the brain and spinal cord. Reducing this inflammation may help to reduce the build-up
of disability over time.
Inflammation doesn't always result in a relapse or any visible symptoms. This silent activity may mean
that although you are feeling well, there may still be changes caused by your MS that can only be seen
on a brain scan. Treating the visibly active (relapses) as well as the silently active aspects of MS is
a new goal that is emerging in MS treatment. This goal is often called 'no evidence of disease activity'
(NEDA). The aim is to reach a point where you are free of visible (relapses) and invisible (changes
seen only on brain scans) MS disease activity.
The Right Time To Begin Treatment
There is increasing evidence of the importance of beginning treating relapsing remitting MS as soon as
possible. This means starting one of the approved medications soon after your diagnosis. However, if you
have waited and are late to begin treatment, it's still better to begin late rather than not at all. So
even after having had MS for some time, you could still benefit by beginning treatments since it may
still help prevent further damage from occurring.
Your doctor should be wanting you to begin on a treatment shortly after being diagnosed. If you haven't
heard them talking about or expressing its importance, then it's important for you to raise the topic
of starting treatment soon. It's perfectly fine for you to bring this or any other topic up with your
doctor because it's your body that's on the line.
The Consequences of No Treatment
Since MS is condition that's varies so much and so differently for each person, it's difficult to know
how your own MS will develop, predict how many relapses you may have, or when a relapse may occur. If you
have had very few relapses or you currently feel well, you may feel that you don't want to start on a
treatment. You may want to look to other options or you may wish to continue life as you were before.
Relapses can only be the tip of the iceberg when it comes to MS, and there can be other activity going
on beneath the surface that you might not be aware of. Typically, permanent damage is caused before any
outward sign has appeared. Without the treatment of MS medications, you are also at risk of further relapses
and permanent nerve damage.
Some people decide to try managing their MS through lifestyle changes. They want to see if, for example,
improving diet, exercising or taking complementary medicines might help. Now ensuring that you are eating
a balanced diet, getting good exercise and not smoking will benefit your health and reduce your risk of
developing other health conditions. However, there is no evidence that these lifestyle changes
alone will make a difference to the course of MS. It's generally accepted that these lifestyle changes
are complementary to drug treatment and part of a holistic management of MS, but they are not a
substitute for DMTs.
It's important to remember even if you decide you don't want to start treatment now, you can change
your mind later and begin then. If your doctor has suggested you start DMT now but you would rather wait and
see what happens or would like to try something else first, discuss your thoughts and decision with them.
You can perhaps come to an arrangement whereby you can test out your way first and review with them after
a set period, to see if that's working for you or if you perhaps wish to reconsider your DMT options.
The Determining Factors For Making A Choice
How do I take the drug? (Administered)
||Intravenous infusion at doctors office or infusion center
How often do I need to take the drug? (Frequency)
||Every other day
||Three times a week
||Every 2 weeks
||Every 4 weeks
Frequency visiting doctor for monitoring and tests? (Testing)
||More than monthly in the first year
||Every 3 months
||Every 6 months
How much will each medication cost me? (Insurance)
||No co-pay - no cost
||Cost of a prescription drug - minimal cost
||Cost of a medical treatment - medical deductible cost
||Not covered - full cost