Relapsing-remitting multiple sclerosis (RRMS) requires ongoing treatment to help manage periods of relapse (also called attacks). However, treatment for RRMS can be just as complex as the disease itself. It’s common practice to try various new therapies to figuring out which works best for you. If you’re thinking about switching RRMS medications, here’s a list of eight things you need to know and to talk to your doctor about before making any changes.
1. RRMS medications prevent disease progression
The primary role of RRMS medications is to stop the progression of the disease. This can also help prevent the onset of disability. While your medications may alleviate some symptoms during “active” periods, it’s important to know that the primary role of conventional medicine is to stop RRMS in its tracks.
Disease-modifying therapies (DMTs) continue to be the primary form of treatment for RRMS. These work by decreasing the number and intensity of relapses. You may also accumulate fewer lesions (plaques) on the brain over time.
2. Switching RRMS medications is a common occurrence
The need to switch RRMS medications isn’t an isolated occurrence. In fact, the World Journal of Clinical Cases estimates that between 30 and 80 percent of all those with MS discontinue a DMT at some point during treatment.
Aside from side effects, you might need to change medications because your current DMT isn’t alleviating your symptoms, or symptoms are worsening. You may also need to change medications if you experience disease progression despite treatment.
3. You may not receive the strongest treatment at first
DMTs are extremely powerful. They may even cause side effects in some people. While controlling the progression of RRMS depends on taking DMTs as soon as possible, your doctor may not prescribe the strongest dosage at first.
They may instead place you on a moderate dosage to see how your body responds. If you respond well to a moderate dosage, then your doctor may increase the dosage as needed.
4. Switching medications depends on the number of relapses
Symptoms can govern the way you manage them. At the same time, the number of relapses you experience can also determine your treatment plan. As a rule of thumb, the World Journal of Clinical Cases says that those who experience one or more relapses in a 12-month time frame may need to switch their DMTs.
5. DMTs come in a variety of forms
Not all DMTs are created equal, both in intensity and method of administration. The following are the types of DMTs available:
- interferon-beta-1a (Avonex, Rebif)
- interferon-beta-1b (Betaseron, Extavia)
- glatiramer (Copaxone, Glatopa)
- peginterferon-beta-1a (Plegridy)
6. Switching meds doesn’t mean you don’t need to seek other treatment measures
DMTs are essential in slowing the progression — and subsequent disability — related to RRMS. However, switching to a stronger drug doesn’t mean you shouldn’t avoid other methods of disease management. Physical occupational therapies, for example, can help you maintain independence while building strength. Speech therapy may also help.
7. Stable MRI tests can mean your treatment plan is working
The course of RRMS varies between people — no one will experience the exact same symptoms, nor will they experience similar lengths of activity and remission. So diagnostic and treatment plans are largely based on a combination of symptoms and MRI activity. Neurological testing through an MRI lets your doctor gauge if there are any new plaques on your brain.
During active periods, your RRMS may cause symptoms. However, the presence of symptoms doesn’t always mean the disease is progressing. MRI testing can help make this determination. If a test doesn’t show a progression of MS, then your current treatment plan is likely working. You don’t necessarily have to switch medications.
On the flipside …
8. Remission doesn’t necessarily mean you’re on the right treatment plan
The term “remission” in RRMS can be easily misunderstood. In this sense, remission refers to a noticeable lack of symptoms. However, this doesn’t mean that your RRMS isn’t progressing. Even if you don’t have new or worsening symptoms, an MRI test may reveal new activity.
Be sure to follow up on all recommended tests for RRMS — even if you’re feeling better. Neurological changes revealed through MRI testing may require more aggressive treatment. This may mean switching RRMS medications.
People with RRMS may switch medications because their current treatments aren’t working, the side effects are severe, or if there are indications that the disease is progressing. Whatever the reason, it’s essential that you follow your doctor’s treatment recommendations. Also, never stop taking medications just because you’re feeling better — this could derail your treatment plan.