Nearly 30 years ago, the U.S. Food and Drug Administration (FDA) approved the first disease-modifying therapy (DMT) for MS: Betaseron, a formulation of interferon beta-1b. Since then, the FDA has approved around 20 additional DMTs — more than half of which secured approval in the past 10 years. This flurry of new treatments means people living with MS have an abundance of options to help reduce flares and slow disease progression.
Thousands of MyMSTeam members have self-reported which DMTs they’ve tried. In this article, we’ll take a look at which DMTs have been used most by members and what trends they reveal.
Bear in mind that “most prescribed DMTs” doesn’t necessarily mean “best DMTs” nor “most effective DMTs.” MS affects everyone differently, and some medications work better for some people than for others. Additionally, some DMTs are only prescribed for certain types of MS. It’s also the case that older medications have been used by more people, since they’ve been available for longer.
MS is an autoimmune disease in which a person’s immune system attacks their central nervous system, eroding the myelin coating around the nerves. DMTs, also called disease-modifying treatments, target a person’s immune system in different ways to reduce attacks on the central nervous system.
DMTs are administered in one of three ways:
DMTs differ from other MS medications like corticosteroids or prednisone, which address specific symptoms of MS but don’t slow disease progression or prevent new flares.
Notably, nearly a dozen DMTs are considered highly effective (HE), based on how they’ve performed in clinical trials — research studies that test the effectiveness and safety of drugs.
The table below lists the FDA-approved DMTs MyMSTeam members have reported using, and how many members have used each (as of this article’s publication date). The chart also includes whether each treatment is considered highly effective.
|DMTs Used by MyMSTeam Members|
|MyMSTeam members have self-reported which DMTs they’ve tried over the years. Here’s the list, from the most prescribed to least prescribed. Note: It’s common for one member to have switched DMTs and used several over time.|
|Drug (Brand)||MyMSTeam Members Reported Taking||Year of FDA Approval||How It’s Taken||Highly Effective DMT?|
|Glatiramer acetate (Copaxone, Glatopa)||27,421||1996||Injection||No|
|Interferon beta-1a (Avonex, Rebif)||21,787||1996||Injection||No|
|Dimethyl fumarate (Tecfidera)||16,672||2013||Orally||No|
|Interferon beta-1b (Betaseron, Extavia)||6,282||1993||Injection||No|
|Peginterferon beta-1a (Plegridy)||1,076||2014||Injection||No|
|Rituximab (Rituxan)||917||Not FDA-approved for MS; prescribed off-label||Infusion||Yes|
|Diroximel fumarate (Vumerity)||78||2019||Orally||No|
|Monomethyl fumarate (Bafiertam)||0||2020||Orally||No|
MyMSTeam Members’ Top 5 Most Commonly Taken DMTs
Following are the five DMTs that most MyMSTeam members have reported taking, along with more detail about each medication.
The FDA has approved various formulations of glatiramer acetate over the years: Copaxone in 1996, Glatopa and other generic versions in 2015. It’s indicated for multiple forms of MS, including clinically isolated syndrome, relapsing-remitting MS, and secondary progressive MS. The drug is injected subcutaneously (under the skin).
Glatiramer acetate is an immunomodulator. The drug incorporates several of the amino acids (protein molecules) that make up myelin. Scientists believe glatiramer acetate may act as a decoy for the immune system to attack instead.
A total of 27,421 MyMSTeam members report having used a formulation of glatiramer acetate.
Like glatiramer acetate, interferon beta-1a is indicated for various forms of MS.
Interferon beta-1a is also an immunomodulator. Beta interferons are human-made versions of interferons, proteins the body naturally produces to reduce inflammation. Less inflammation means less nerve damage from MS.
A total of 21,787 MyMSTeam members have reported using a formulation of interferon beta-1a.
The FDA approved a formulation of dimethyl fumarate in 2013 called Tecfidera. The drug is taken orally — usually twice per day. It’s indicated for adults with relapsing types of MS.
Dimethyl fumarate is an Nrf2 activator. Nrf2 is a type of protein that helps protect cells from damage. Scientists believe it works by decreasing the number of lymphocytes (white blood cells) in the body, which in turn reduces autoimmune attacks on the nervous system.
A total of 16,672 MyMSTeam members have reported using this drug.
Tysabri, a formulation of natalizumab, secured FDA approval in 2004 — but Biogen pulled it off the market in 2005 after two people taking the drug developed brain infections. In 2006, the drug returned to market. Natalizumab is the first highly effective DMT on this list of medications taken by MyMSTeam members. The drug is indicated for people living with relapsing forms of MS, and it is usually taken via IV infusion every 28 days.
Natalizumab is classified as a monoclonal antibody medication, also known as a biologic. Scientists believe it works by attaching to lymphocytes and keeping them from accessing the central nervous system, thereby preventing them from attacking the brain and nerves.
A total of 11,069 MyMSTeam members have reported using this drug.
Fingolimod is also considered a highly effective DMT. The FDA first approved a formulation of the drug in 2010, called Gilenya. Taken orally in capsule form, the drug is indicated for people with relapsing forms of MS.
Fingolimod is classified as a sphingosine l-phosphate receptor modulator. It decreases immune cell activity that may damage nerves. It is taken orally as a pill once a day.
A total of 8,835 MyMSTeam members have reported that they use or have used fingolimod.
Scouring the data reveals some interesting trends about which types of DMTs MyMSTeam members commonly take.
The two most commonly prescribed DMTs for MyMSTeam members, glatiramer acetate and interferon beta-1a, are administered via injection. In fact, seven of the top 10 most prescribed medications among MyMSTeam members are administered monthly via injection or infusion. It’s also worth noting that injected DMTs have been on the market longer than oral medications, so it makes sense that more people will have tried them.
Compared with oral medications, injected DMTs are taken less frequently. And one advantage injectables have over infusions is that they can be administered at home, saving a monthly trip to a clinic.
Oral medications are still commonly reported by MyMSTeam members, though. Two of the top five medications on the list come in capsule form — dimethyl fumarate and fingolimod.
Newer MS treatments haven’t rendered older, tried-and-true options obsolete. The FDA-approval dates for the top 10 DMTs on the list span 1993 (for interferon beta-1b) to 2017 (for ocrelizumab, sold as Ocrevus).
DMTs that meet certain criteria earn a “highly effective” classification. While they’re clinically proven to slow the progression of MS and to reduce disability, they can also potentially cause rare but serious side effects.
Among the top 10 DMTs on the list, there are four HE DMTs: natalizumab, fingolimod, ocrelizumab, and alemtuzumab. Natalizumab has been on the market since 2004, and fingolimod has been available since 2010, making them the oldest FDA-approved HE DMTs on the list.
The six remaining HE DMTs — four of which were approved in 2019 or later — fall in the bottom 10.
There are two notable HE DMT outliers on the list. The first is rituximab (Rituxan). The FDA hasn’t approved the drug for treating MS, but some doctors prescribe it off-label. Such has been the case for nearly 1,000 MyMSTeam members.
The second outlier is mitoxantrone. This HE DMT was approved in 2000 under the brand name Novantrone, which has since been discontinued. It’s still available as a generic drug, however, and is used for treating various forms of MS. Just over 200 MyMSTeam members have used this drug.
If the DMT you’re taking isn’t high on this list, don’t worry. This list isn’t a ranking of DMT quality or effectiveness — and you should be wary of any source that tries to convince you there’s such a thing as “one best treatment for MS.”
However, if you have concerns that the DMT you’re taking isn’t meeting your treatment goals, speak with your doctor. Even if you’ve been satisfied with your medication for years, researchers agree that most DMTs can lose effectiveness over time. By collaborating with your health care provider and advocating for your priorities and preferences — a process called shared decision-making — you may decide together that it’s time to switch to a different DMT.
MyMSTeam is the social network and online support group for people living with multiple sclerosis and their loved ones. On MyMSTeam, more than 195,000 people come together to ask questions, give advice, and share their stories with others who understand life with MS.
How many DMTs have you tried? Are you more likely to choose an older, more established DMT or a newer one? Share your experience in the comments below, or start a conversation by posting on your Activities page.