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How to Weigh the Pros and Cons of Switching RRMS Medications

Written by Sherman Jia, MD on April 26, 2017
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Knowing if your current relapsing-remitting multiple sclerosis (RRMS) medication is working the way it should be isn’t always easy. On top of that, knowing when or how to switch can be worrisome. Your MS neurologist is there to help you make decisions about switching RRMS treatment.

Currently, 15 therapies are approved by the U.S. Food and Drug Administration (FDA). Navigating the benefits and risks of each may be overwhelming, and often more than one treatment may be effective for each person. In addition, your medical history may result in adverse responses to different therapies. For these reasons, selecting or switching therapies should always be done with guidance from a physician.

All MS treatments aim to reduce the severity and frequency of attacks, and to delay disability. As well, approved therapies may significantly improve your quality of life.

Because RRMS affects everyone differently, there is no single drug that is best for everyone. A person with mild-to-moderate disease may be well-controlled on an older injectable therapy. Another who has more severe attacks may require a newer infusion therapy.

However, if the disease is well-controlled and you don’t experience significant side effects, there is no reason to change your current treatment.

How MS treatments work

All MS treatments modulate the human immune system, which exists to fight foreign bugs. They span a range of effectiveness and side effects. In general, a less effective treatment may cause fewer side effects, and a more potent therapy may cause more serious side effects.

Common side effects include injection- or infusion-related reactions. Rare side effects include organ-specific toxicity, dangerous infections, secondary autoimmune disease, and cancer.

There are ways to minimize both common and rare side effects, and with proper monitoring, it may be safe to use most approved MS therapies. It’s important to understand the potential side effects of a treatment prior to starting or switching therapies.

5 reasons to switch treatments

There are several reasons for switching therapies. Here are five:

1. You have frequent or debilitating MS attacks on your current treatment

Many MS neurologists consider treatments to be effective six months after starting the therapy. There aren’t consensus guidelines for switching therapy. But having two or more attacks per year after six months of treatment, especially if they’re debilitating, may be an indication that your current therapy isn’t working.

2. The side effects outweigh the benefits of a treatment

To put it simply, MS therapies cause side effects that affect quality of life, injury to your body that’s only detected on testing, or both.

For example, one reason to switch treatments is if you test positive for the John Cunningham virus antibody positive while taking natalizumab (Tysabri). This increases your chance of developing a fatal brain infection called progressive multifocal leukoencephalopathy.

In general, you should follow up regularly (at least once per year) with your MS neurologist to discuss any side effects. You’ll also want to review blood or other tests to ensure your long-term safety while on a treatment.

3. The route or frequency of therapy delivery creates a barrier for taking a treatment consistently

Some MS treatments, such as daily injections or twice-daily pills, are less convenient and may prevent you from taking the treatment regularly. A therapy is only effective if used consistently.

If taking a treatment regularly is challenging, speak with your MS neurologist to find out if another therapy may be right for you. More convenient options, such as daily oral medication or a monthly or biannual infusion, may be available. However, be aware these may cost more than your current treatment.

4. You’ve changed insurance

A change in career or employment may cause a switch to insurance that no longer covers your current MS treatment. If this happens and your current treatment is working, speak with your MS neurologist about ways to contact your insurance to cover the current therapy. Or discuss other therapies that are covered by your new insurance plan.

5. You’re planning a pregnancy

Of the 15 MS therapies available, the FDA has approved none for use during pregnancy. While each MS neurologist approaches pregnancy differently, most recommend stopping MS treatment a few months prior to pregnancy and restarting treatment after delivery.

It’s possible to get a one-time infusion of a B-cell therapy — rituximab (Rituxan) or ocrelizumab (Ocrevus) — to “bridge” the time between stopping therapy and the third trimester of pregnancy. This is when the risk for attacks is reduced.

The takeaway

Speak with your MS neurologist to understand if you’re on the best treatment for you, and to discuss if there’s a compelling reason to switch to another therapy.

How to adjust your daily routine when you start a new RRMS medication »

Disclosure: At the time of publication, the author has no financial relationships with MS therapy manufacturers.

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