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