There are many DMTs for managing MS, each one with a different amount of effectiveness and safety. Typically, people with MS and their healthcare professionals decide on a DMT based on the level of disease activity. However, there is a new school of thought among neurologists to start on a high-efficacy DMT earlier in the treatment journey.
What is a disease-modifying therapy (DMT)?
The benefits of early DMT treatment in MS
Multiple sclerosis (MS) is a progressive condition, but studies show treating your MS early on can help reduce relapses, limit magnetic resonance imaging (MRI) changes, and slow disease progression. You and your healthcare professional can choose from a variety of medicines, called DMTs, to manage your MS.
DMTs can be used from the beginning of your MS journey and onward. It can be helpful to start the right DMT as early as possible to better manage your MS.
Your healthcare professional will advise on and help you consider your options when it comes to DMT use.
Higher-efficacy DMTs may be worth considering for early MS
While high-efficacy DMTs may come with more side effects, the benefits may be greater when they’re used earlier.
Studies show that people with relapsing-remitting MS (RRMS) who started on a high-efficacy DMT early had slower disability progression than those who started with a
Side effects from DMT use may increase or seem more drastic as you age due to other medical conditions that are more likely to arise later on in life. So, if appropriate, it may be worthwhile to start on a high-efficacy DMT sooner while the benefits may be greater.
Of course, understanding how each DMT was studied and in what population the DMT was studied in may also help you weigh the benefits and risks of different DMTs.
Typically, the most informative studies are the ones that compare the performance of one DMT against another. However, depending on which DMT options are appropriate or available to you, other studies that only compare the performance of a DMT against a group of people who have not taken anything (placebo) can also help you decide on a treatment. The difference between these types of studies is often considered when your healthcare professional is coming up with a treatment plan.
Moderate- and high-efficacy DMTs also come in a variety of forms, including injectables and orals (taken by mouth). Talk with your healthcare professional to see which type of DMT is right for you.
What to consider when choosing a DMT
Whether you’re just starting on a DMT or switching medicine, there’s a lot to consider. You and your healthcare professional will want to weigh several factors when making treatment decisions, including:
Type of MS (such as RRMS or other forms of MS)
Level of disease activity
Any recent MS-related events you’ve experienced, like a relapse
How you experience MS
How other factors impact your daily life
Your desire to start a family, now or in the future
Your lifestyle choices (eg, career considerations, traveling for work or pleasure)
Your short- and long-term goals and plans for the future
The MS symptoms you want to focus on managing
Other existing medical conditions
Potential interactions with other drugs you are taking
Your need for additional health monitoring
Comfort level with the different methods of taking DMTs (eg, self-injecting, swallowing pills, traveling/waiting for infusions)
Potential issues with taking your DMT as prescribed
Drug cost and insurance coverage
How well the DMT works to manage MS
Whether it’s your first DMT or you’re switching
Possible side effects
How the DMT is taken (injection, oral, infusion) and how often
Whether the DMT can be taken at home or if you have to go to a medical/infusion center
Whether the DMT needs to be taken with food or if it has food restrictions (for oral forms)
How the DMT is started
Any special storage requirements (eg, refrigeration)
Each person responds to DMTs differently. Also, a DMT that may work for you today may not be right for you in the future. Talk to your healthcare professional about all your options so you can decide on the treatment that’s best for you.