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What Is Highly Effective Treatment for MS?

Updated on July 22, 2022
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Brooke Dulka, Ph.D.

  • Highly effective (HE) disease-modifying treatments (DMTs) can help slow the progression of multiple sclerosis (MS) and reduce disability.
  • Highly effective DMTs also have the potential to cause rare but serious side effects.
  • Your doctor can help you carefully weigh the decision to switch to a highly effective DMT in a process known as shared decision-making.

It is common for people with multiple sclerosis (MS) to try to switch therapies in the quest to manage symptoms and slow progression of the disease. Drugs used to slow the progression of MS are called disease-modifying therapies.

Highly effective DMTs have received much attention in recent years, and they are increasingly being recommended as the initial treatment for some people with relapsing forms of MS. Since HE DMTs can also carry the risk of serious side effects, it is important to understand all of the risks and benefits involved.

What Are Highly Effective DMTs?

DMTs slow the progression of MS. They do this by targeting the immune system to reduce its attacks on the central nervous system. MS is considered an autoimmune disease because the body essentially attacks its own nerves and brain cells.

The HE DMTs are a group of medications for MS that have been deemed to be highly effective based on how they performed in clinical trials compared to other existing treatments. HE DMTs include MS medications in several different drug classes, including sphingosine-1-phosphate (S1P) receptor modulators and anti-CD20 monoclonal antibodies. HE DMTs in different classes work in different ways to slow the progression of MS.

Examples of Highly Effective DMTs

Many different HE DMTs are now approved by the U.S. Food and Drug Administration (FDA). HE DMTs currently available include:

Are you thinking of switching to a highly effective DMT for multiple sclerosis?
Click here to start a conversation in the comments below.

Measuring Effectiveness

Measuring effectiveness is important because it lets a physician know if a treatment option is working for an individual who has MS. It also helps classify different prescriptions as being moderately effective, highly effective, etc.

But how is effectiveness measured? Briefly, there are three main ways doctors monitor the effectiveness of an MS treatment. A doctor’s recommendations on whether to continue or switch medications are mainly based on:

  • MRI results and lab tests that measure disease progression
  • The frequency of MS relapses (also called disease flares or MS episodes)
  • How disability progresses over time

Because your doctor understands how your MS has progressed and how you have responded to DMTs, they can recommend which DMT is most likely to be effective for you if you decide to switch.

Watch MS specialist Dr. Aaron Boster discuss whether everyone with relapse-remitting MS will get secondary progressive MS.

Benefits of Starting a Highly Effective DMT Early

The earlier someone with MS starts HE DMT treatment, the greater the likelihood that the treatment will effectively slow their MS progression. For instance, research has shown that 68 percent of those who started treatment with HE DMTs reached the goal of no evidence of disease activity (NEDA) after 12 months of treatment. Moreover, 52.4 percent reached NEDA after 24 months of treatment. This can be compared to 36 percent (after 12 months) and 19.4 percent (after 24 months) of those who started a moderate efficacy DMT as a first drug instead.

Although starting HE DMTs earlier is better, your neurologist may not recommend one as a first therapy due to concerns about side effects.

Side Effects of Highly Effective DMTs

Unfortunately, HE DMTs are sometimes associated with the risk of more serious side effects. It is important to note that some of these side effects occur very rarely. Additionally, each individual has a different risk based on their medical history, inherited risk factors, and overall health. Your doctor is the best person to help you assess your personal risk for each side effect.

More serious adverse side effects of HE DMTs can include:

  • Cardiomyopathy, a disease of the heart muscle
  • Opportunistic infections, such as herpes simplex virus 1 or salmonella
  • Basal cell carcinoma, a type of skin cancer
  • Lymphoma, a cancer of the lymph nodes, spleen, thymus gland, and bone marrow
  • Macular edema, an eye disease
  • Progressive multifocal leukoencephalopathy, a disease of the white matter of the brain, caused by a virus infection
  • Posterior reversible encephalopathy, a syndrome characterized by a spectrum of neurological and radiological features such as headache, seizures, altered mental status, and vision loss

Weighing Risks and Benefits of Highly Effective DMTs

Like all medications, even those available over the counter, HE DMTs have both their risks and benefits. Safety concerns should be a key consideration when thinking about switching therapies. Additionally, every individual’s safety profile may change as they age, develop additional health conditions, or experience immune system changes. It is expected that the safety risks of certain therapies are likely to be greater as people age.

However, these risks must be carefully weighed against the benefit of reductions in the progression of MS. In shared decision-making, you and your doctor will discuss these risks and benefits, and your goals, preferences, and priorities will be taken into account.

Building a Community

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 178,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Are you thinking of switching to a highly effective DMT for multiple sclerosis? Share your thoughts and experiences in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.

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