Medications, particularly disease-modifying therapies (DMTs), are essential in the treatment of multiple sclerosis (MS). This is especially the case for relapse-remitting MS (RRMS). Forms of RRMS can cause “attacks” during which new lesions form and symptoms escalate. DMTs can also help slow down the progression of RRMS. With ongoing treatment, DMTs may prevent long-term disability.
Still, not all DMTs work the same way in all people. You might be at a point where you’re considering switching medications. Whether you’re thinking about switching or you’ve already made the switch, there are at least nine important reasons you’ll need to see your doctor.
Not only do you need a prescription from your doctor, but the two of you also need an in-depth discussion about why you need to switch your MS medications. In some cases, MRI testing might show new lesions, and you’ll try new meds based on your doctor’s recommendations.
In many other situations though, people ask their doctors about switching medications first. You might want to switch because you think your current treatment isn’t working, or perhaps you’re starting to notice side effects.
Determining precisely why you need to switch medications also helps your doctor figure out which is the right type for you. There are 14 DMTs available, all with different strengths and precise usages.
Whether you’re about to switch medication or you already have, you’ll need to see your doctor for an in-depth evaluation based on your symptoms. They might assess the frequency and severity of:
- bladder or bowel problems
- cognitive changes
Keeping a symptom diary can help your doctor better understand the symptoms you experience during MS attacks. This is especially important when transitioning to new medications.
You’ll also need to see your doctor for a discussion about risks and side effects associated with MS medications. When taking any new DMT, you’re likely to experience short-term flu-like symptoms.
As your body becomes accustomed to the medication, these side effects are likely to improve. However, other side effects may stay. Examples include headache, increased fatigue, and gastrointestinal issues. Certain DMTs (especially more powerful infusions and injections) may even cause changes in your blood and liver cells.
Because medications with stronger disease-modifying agents can affect the way your blood and liver cells work, you’ll need to see your doctor regularly to make sure your own medications aren’t causing these effects. Blood testing can also help detect high cholesterol, anemia, and other health issues that may arise.
In addition to blood tests, your doctor may also need to see you for occasional cerebrospinal fluid (CSF) samples. Increased gamma globulin levels could indicate MS progression.
The primary goal of RRMS treatment is to prevent progression of the disease, so you’ll need to see your doctor for regular MRI scans. These tests for MS look specifically at lesions (plaques) on your spine and brain.
While a neurologist uses an MRI test for the initial diagnosis of MS, you’ll still need to follow up with additional tests to see if any new lesions have formed — these can indicate disease progression. Taking the test can also let your doctor see how and if your new DMT is working.
If you’ve taken DMT injections or oral medications and these haven’t worked, you might be given an infusion. DMT injectable solutions are more powerful than other forms of DMT, and they’re only administered at the doctor’s office. Examples of DMT infusions include alemtuzumab (Lemtrada), mitoxantrone (Novantrone), and natalizumab (Tysabri).
While you’re seeing a neurologist for MS treatment, you may also need to see other types of specialists based on your specific needs and symptoms. Your doctor might refer you to:
- occupational therapy
- physical therapy
- speech therapy
- a psychologist or psychiatrist
- a dietitian
DMTs are the most talked-about medications for MS. However, many also benefit from other medications taken in conjunction with their DMTs. These include:
- steroids for severe symptoms caused by increased
- nonsteroidal anti-inflammatory drugs (NSAIDs)
for pain, such as ibuprofen
- antidepressants for depression or anxiety
- sleeping aids for insomnia
Whenever your doctor prescribes a new medication, you’ll likely need to see them again within weeks or a few months of starting the new treatment. This is to help ensure that the medication works well for you.
“Remission” periods in RRMS tend to have multiple connotations. While remission is often understood as recovery from a particular disease, it means something different with MS. With remission, the disease hasn’t gone away — it just doesn’t cause inflammation and subsequent symptoms.
Even if you’re in a remission period, you’ll need to see your doctor for your regularly scheduled appointments. During this time, you may also need to have MRI or blood tests to detect signs that might otherwise go unnoticed that your MS might be progressing.
Remission doesn’t mean you don’t take action — staying vigilant about your MS remains crucial at all stages of the disease.