With relapsing-remitting multiple sclerosis (RRMS), ongoing treatment is essential. Disease-modifying therapies (DMTs) can help not only to alleviate symptoms, but also to prevent RRMS from progressing and getting worse. This can play a significant role in both your everyday life as well as the long-term prevention of disability.
Yet if RRMS treatments are so essential, then why do they seemingly stop working sometimes? It’s important to remember that RRMS is complex, and that medications don’t work the same in everyone.
This means that a trial-and-error process ought to be expected when it comes to RRMS treatment. While the process can be frustrating, it’s important to know that treatment changes are a regular part of treating this condition.
Still, switching treatments can be overwhelming and confusing. Learn some of the best treatment strategies for switching RRMS medications to make the process a little easier.
Know the reasons others with RRMS make the switch
It’s possible you need to switch DMTs. However, you can’t switch DMTs simply because you want to see how a different medication might work instead. Understanding the exact reasons why you might need to switch medications can help you tackle your broader treatment plan more effectively.
The most common reasons why people switch their medications include:
- increased number of attacks (relapses)
- increased severity of attacks
- new or worsening lesions, as revealed by an MRI
- no signs overall symptoms have improved
- onset of side effects from current treatment
Talk to your neurologist if you have one or more of these reasons for possibly switching medications. The idea is that making changes will help improve these issues while reducing overall disease progression.
Assess all your options
One of the reasons why RRMS treatment is so confusing is that there are so many DMT options. As of 2017, there are 14 FDA-approved DMTs for MS treatment.
The following is a roundup of DMT options:
|teriflunomide (Aubagio)||oral medication|
|interferon-beta-1a (Avonex, Rebif)||first-line treatment|
|interferon-beta-1b (Betaseron, Extavia)||first-line treatment|
|glatiramer (Copaxone, Glatopa)||first-line treatment (Glatopa is a generic version of Copaxone that can save patients money)|
|fingolimod (Gilenya)||oral medication — particularly used to prevent physical disability|
|alemtuzumab (Lemtrada)||used for advanced RRMS, but only if you haven’t responded to two other DMTs|
|mitoxantrone (Novantrone)||for more advanced MS — but only used in cases of worsening RRMS and is particularly helpful in decreasing risk of neurological disability|
|peginterferon-beta-1a (Plegridy)||first-line treatment|
|dimethyl-fumarate (Tecfidera)||oral medication|
|natalizumab (Tysabri)||used for advanced RRMS — can’t be combined with any other DMT|
|daclizumab (Zinbryta)||used for advanced RRMS|
In treating early RRMS, your doctor might recommend a first-line treatment, such as Glatopa or Copaxone. If these medications don’t work, then they might consider a stronger medication such as Lemtrada. Ideally, you’ll start with a more moderate therapy first to decrease the risk of side effects. Stronger agents are only used as a last resort.
Learn the risks and side effects
Each type of DMT comes with specific risks and side effects. More broadly, starting any new medication for MS can cause temporary flu-like symptoms, such as nausea and diarrhea. However, you’ll want to discuss other potential side effects with your doctor. Possibilities include:
- allergic reactions (usually at injection sites)
- chest pain
- skin flushing
DMTs — especially more advanced agents — also carry the risk of affecting liver enzymes and blood cell counts. Although not as common as other side effects, these are potentially very serious risks. Your doctor will likely take occasional blood samples to monitor your condition.
Adhere to your current plan before switching
Making the decision to switch RRMS medications can take some time. Not only do you need to talk to the doctors on your health team, but you also need to weigh your options, as well as specific medication pros and cons.
In the meantime, you’ll need to carefully adhere to your current treatment plan. Simply stopping your medications because you think they aren’t working can lead to worsening issues and progression.
Even if you think your medication isn’t working, it might still be offering some benefit in the way of symptom control and disease progression. Unless otherwise directed by your doctor, keep taking your medications as directed before you switch to a new type.
Bottom line: Work with your doctors every step of the way
Given all the factors that go into making the decision to switch RRMS medications, it’s important to discuss the options with all your doctors. Your neurologist is certainly the first medical professional you’ll speak with, but you’ll also want to talk to your primary doctor. Notifying all medical professionals who are a regular part of your ongoing treatment plan can help reduce the risk for drug interactions. Working together can also help ensure as successful a treatment plan as possible.
If you do make the switch to a different type of RRMS medication, keep a diary of all symptoms as you make the transition. Side effects could possibly warrant another switch in your treatment — you’ll want to tell your doctor about any unusual symptoms right away.