Each Multiple Sclerosis (MS) patient will have a different experience with their disease. Some will have one flare in their lifetime (clinically isolated syndrome) while others may have ongoing relapsing and progression of their disease and disability. Therefore, how treatments are chosen and how often they are changed is individualized per patient. Part of the decision is based on the type of MS with which the patient is diagnosed with (and this too may change over time). The diagnosis is based on the frequency and pattern of flares. The main types of MS include relapsing-remitting MS (RRMS), active secondary progressive MS (SPMS), active primary progressive MS (PPMS), or clinically isolated syndrome (CIS)
Relapses and progression are due to repeated damage to the coating of the nerve cells in the brain and spinal cord which interrupts communication between nerves and muscles. The result is often muscle weakness, fatigue, gait abnormalities and vision changes. Most damage is repaired almost completely and symptoms may resolve entirely. However, as there is usually some damage that remains, repeated injury to the same area of the central nervous system will result in less complete recovery with subsequent flares. Also, certain areas of the brain handle more sensitive functions (such as the brainstem) and a smaller attack may result in more significant disability.
After beginning a new treatment, the patient and the neurologist need to observe for up to a year to determine if it is helping. One study showed that on average it takes three to seven months for these treatments to take full effect.
The medications are called Disease-modifying therapies (DMT’s) which target the inflammation in the brain and spinal cord that underlies the relapses as the body’s own immune system attacks itself. There are different classes of DMT’s, with the more recent group called “high-efficacy DMT’s” (HE) because they are particularly effective. Not surprisingly, there may be more adverse events with the HE therpaies.
Seeking a more effective treatment because of disease progression is not the only reason MS patients are switched to different therapies. Sometimes the body develops antibodies that make a particular therapy less effective. Sometimes a patient will have intolerable side effects. Sometimes the route of administration of a drug may be more attractive, such as oral vs intravenous or self-injection. Sometimes a different drug may be less expensive or be covered by health insurance.
The answers a patient should seek before making the switch is to find out how long it will take a new therapy to kick in (the therapeutic lag), how is the drug administered (a pill or injection, for example), how often is the medication administered and will there be “down-time” after each administration when there are side effects, does the new drug tend to wear off before the next dose, and, very importantly, what are the potential risks of the new drug (cancer, allergic reaction). The good news is that there are many options, In fact, the FDA has approved over 25 DMT’s over the last 20 years. The decision about switching to a new medication should be a decision made jointly by the patient and the doctor. The more information a patient has, the larger a role she can play in navigating her own care.
BeCare MS App can help you and your doctor monitor for progression and help you decide when it is time to make a change. Become empowered; be a driver in your own MS journey.