Relapse-remitting multiple sclerosis (RRMS) is the most common form of multiple sclerosis (MS). You may have periods where no symptoms occur (remittance), followed by bouts of worsening symptoms (relapse). Sometimes the symptoms become permanent during remittance.
As inflammation chronically affects the central nervous system, symptoms and overall disease progression can be difficult to predict. With RRMS, the symptoms may worsen over time. Subsequently, your treatment plan may require modification.
Based on your symptoms, you may be thinking about switching your medications. While switching RRMS medications might be helpful, this isn’t necessarily a smooth transition. Before you stop your current treatment plan and start up another one, be sure to discuss safety considerations and the possibility of worsening symptoms with your doctor. You will also need to understand all dosing information.
Why you may need to switch medications
The primary goal of MS medications (disease-modifying therapies, or DMT) is to help slow down disease progression. The Cleveland Clinic recommends changing DMTs if your RRMS causes intolerable side effects or if your condition has gotten worse.
Symptoms can also indicate whether or not a DMT is working properly. Common symptoms of RRMS include:
- blurry vision
- excessive fatigue
- memory changes
- weakness in the legs
If you’re already on medication and experience the above symptoms in a new or worsening fashion, then it’s time to consider a new DMT. Patients usually make this type of switch after six months of seeing no improvements with their old medications.
Your doctor will also consider the number of relapses you’ve had in the past year. This helps avoid the danger of overmedicating, thereby reducing your risk of drug side effects. At the same time, the more recent your relapse, the most likely you’ll respond to a new DMT.
Types of RRMS medications
DMTs come in the form of injections as well as oral tablets. Some are also delivered intravenously (through a vein).
In addition to DMTs, your doctor may prescribe medications to treat symptoms that are directly related to RRMS. For example, your doctor might recommend antidepressants for anxiety or depression, as well as medications that reduce muscle spasms (such as baclofen). It’s important that you don’t stop taking these types of medications just because you suspect your current DMT isn’t working. Your doctor will evaluate all of your current meds and help you adjust accordingly. Suddenly stopping any drug can cause increased symptoms, such as worsening depression when abruptly stopping the use of an antidepressant.
Safety considerations and side effects
The following side effects are associated with RRMS medications:
- eye swelling (macular edema)
- flu-like symptoms
- flushing of the skin
- gastrointestinal discomfort
- herpes infections
- high blood pressure (hypertension)
- increased liver enzymes (which indicates liver inflammation)
- skin reactions (in the case of injectable meds)
- thinning hair
- worsening thyroid symptoms (in the case of preexisting related diseases)
Regular blood testing can help ensure that any new DMT for RRMS isn’t adversely affecting the body. However, if you see any new or worsening symptoms, it is likely related to your new medication. At this point, you may talk to your doctor about switching DMTs to get rid of these side effects. If you take multiple DMTs, this process may take time.
Occasional MRI tests are also needed to help detect changes from MS-related inflammation. These tests are done once or twice a year, depending on the severity of your condition. Through an MRI, your doctor will look for any new cerebral lesions, which often have no symptoms. You may also need to stop medications if you have new lesions and worsening disability without any notable relapses.
Bottom line: Switching RRMS medications requires careful monitoring
Despite all of the important considerations that need to be made before switching RRMS medications, your doctor is the ultimate source for guidance. They will carefully monitor your condition as you transition between your meds in case there are any red flags that a certain medication isn’t working.
The good news is that RRMS responds best to medications compared with other forms of MS. Still, it can take some trial and error before you find the right therapies for your specific condition. Keep in mind that all patients respond to MS therapies differently, so continue touching base with your doctor to see if your current plan is the best fit.