8 Tips For Choosing an MS Disease Modifying Therapy

Soon after the diagnosis of MS is confirmed, your MS provider will want to discuss MS disease–modifying therapy (DMTs). These MS treatments, which affect the body’s immune system, modify MS disease activity. They reduce episodes of symptoms, known as relapses, and limit the progression of the disease over time. There are over 20 DMTs for MS, which is a lot to consider when making a treatment decision. 

DMT Decision Process

Some people might be inclined to say, “Doctor, please just tell me what to do” – and sometimes this is exactly what happens. Doctors telling us what to do used to be commonplace, but now research tells us that when we are active participants in treatment decisions, our outcomes are better: 

• Better adherence to treatments, which is associated with better outcomes 
• Better ability to manage side effects 
• More satisfaction with their healthcare 
• Improved communication with their healthcare team 

The process of making medical decisions collaboratively with your healthcare provider is called “shared decision-making.” In this process, you and your healthcare provider work together to make decisions and select tests, medicines, treatments, and care plans based on clinical evidence that balances risks and expected outcomes with your preferences and values. 

8 Tips To Help You Participate Effectively in the Decision

Here are a few tips to help you participate in decisions about your MS Disease-Modifying Therapy

1. Gather information.
   With over 20 DMTs currently FDA-approved, there is a lot of information to sort through. But learning about the purpose of these treatments and how they are thought to work will help you have an informed discussion with your MS provider. Take a look at our information on MS DMTs so that you are prepared for a conversation with your MS provider. Write down your general questions about DMTs and how they are thought to work. 
2. Think about your goals for taking the DMT. 
   What do you hope will happen as a result of taking the MS DMT? Your goals are as important to decision-making as the MS provider’s knowledge about the treatments. Let your MS provider know what is important to you.
3. Make a list of your questions about side effects and risks.
   You may be anxious or even a little scared about starting a DMT. This is a big decision, and some of the side effects listed about the medicines are frightening.  Some of your questions might include:
   
   • • What are the side effects of the DMTs? 
     • Are there short- or long-term risks of the DMTs? 
     • Can these medications be taken during pregnancy or breastfeeding? 
   • • What is the impact of these medications on COVID or other vaccines? 
     • Are there tests or scans I will need to monitor my safety while on treatment? 
4. Are there alternatives to an MS DMT?
   While the research shows that MS DMTs can help modify the MS disease process, you may be reluctant to start and want to explore alternative MS treatment options. Share your concerns with your MS provider. Consider questions such as: 
   
   • • What are the pros and cons of starting a DMT right away?
     • What are the risks of waiting to begin treatment?
     • What if I am planning to start or add to my family in the coming months?
5. Consider the pros and cons of high efficacy MS DMTs.
   You may have read about some MS DMTs being “better” than others. Often, they are referring to high efficacy MS DMTs, which have a higher risk of side effects but significantly reduce the frequency of relapses. Read more on that here. During your conversation with your doctor, consider asking some or all of the following questions: 
   
   • • What is a high efficacy DMT?
     • Who should be on a high efficacy DMT?
     • How do I know if a high efficacy DMT is right for me?
     • Do high efficacy DMTs have more risks or side effects? 
     • What are the advantages or disadvantages of starting with a high efficacy MS medication?
       
6. Learn how the different medications are taken.
   Properly adhering to your medication and taking it exactly as it’s prescribed is crucial to maintaining your overall well-being. Even though this may seem obvious, studies reveal that adherence to medications, including those for MS, hovers at around 50%. Consider the factors that will make it easier for you to adhere to your medication:   
   
   1. • How do you feel about oral, infused, or injected medications?
      • Does the frequency of dosing or how the medicine is taken or delivered fit your lifestyle?
      • If the treatment requires visits to the provider’s office, are you able to take time off work or away from home responsibilities? 
      • If the treatment is self-injected, do you believe that you can give yourself a shot?
7. Cost of MS treatment is important to your DMT decision
   MS medications are expensive. Insurance covers some but not all of the cost, and most insurers have only some of the MS medicines on their formulary (the list of drugs they cover). You will need to know:   
   
   • • If the treatment is covered by your insurance – or if programs offered by the drug manufacturer can help you with the cost. 
     • What will your out-of-pocket cost be before you get the medication?
8. Is a clinical trial an option for you?
   Perhaps you are interested in a clinical trial of a new medicine for MS. Your MS provider can let you know if a clinical trial is recruiting in your area and if you might qualify.

Summary

We hope these tips will help you participate more comfortably and effectively in the shared decision-making process with your MS care provider. Combining their expertise with your personal goals, values, and priorities is the optimal way to make your treatment work for you.