Which Medicine Should I Start Taking?
Exploring MS medicines.
The vast majority of patients with MS, or an initial attack suggestive of MS (clinically known as isolated syndrome), will receive advice from their doctor to start on a medication.
Currently, there are two classes of medicines that are used as initial therapy in most patients: the interferons and glatiramer acetate (Copaxone®).
The three versions of interferon are called Avonex® Betaseron® and Rebif®. These interferons are very similar medicines, and differ primarily in the dose of the medicine and the frequency they are taken. Avonex is injected once a week into the muscle, while Betaseron® and Rebif® are injected three times per week under the skin. Copaxone is a daily injection under the skin.
These four medicines are good for the following reasons:
- They are old. There is nearly 20 years of experience with these medicines, and they have been taken by millions of people around the world.
- They are safe. While these medicines are not free of side effects, to be sure, serious, permanent side effects are exceedingly rare. Many patients take these medicines under the mistaken belief that they will suppress their immune system and they will be vulnerable to infections. This is not true. In short, these medications are much safer than Aspirin and many over-the-counter medications.
- They work. The effectiveness of these medicines is well-established both in clinical trials and in clinical practice. They are effective in decreasing relapses, by about 33 percent, and in preventing disability.
These four medicines are bad for the following reasons:
- They are all injections. Yuck! No one likes needles.
- They have side effects. The interferons can cause both injection-site reactions and flu-like symptoms in a substantial number of people. Copaxone is only very rarely associated with general side effects, but patients can develop painful injection site reactions and cosmetically unpleasing fat breakdown at the site of the injection. Most people are able to get used to these side effects, and there are some strategies to make these medicines more tolerable. However, a certain number of people find these medicines intolerable, and for them, the treatment may be worse than the disease.
- They are not a cure. While these medicines are highly effective in some patients, for others they are simply not strong enough to prevent relapses and the accumulation of disability.
Although neurologists love to quibble about the details, overall, most MS specialists consider these medications to be much more similar than different on a variety of parameters. It is my practice to let patients choose which medication to start with, though I will certainly choose one if they ask me to do so.
Often patients anguish and debate about which medicine to start taking. This is unnecessary. While the decision about which medicine to choose is an important decision, it is not a major decision, in my opinion, simply because it is so easy to reverse. If a patient has a problem with one medication, it is a simple matter to switch to another one.