Questions to Ask Before Starting a New MS Medication

Disease-modifying therapies (DMTs) are often included in a treatment plan for multiple sclerosis (MS). These medications have been shown to reduce the number of relapses, slow the progression of disability, and limit new disease activity, as seen on magnetic resonance imaging (MRI). Twenty-three DMTs are approved by the Food and Drug Administration (FDA) for MS.

During treatment, there are instances in which you or your healthcare provider may want to change your MS medication. Some people may experience side effects that become intolerable. In other instances, new lesions on an MRI (areas affected in the brain or spinal cord) or frequent relapses may indicate that the chosen DMT is no longer effective.

Whether starting a DMT for the first time or switching medications, you have the right to informed consent. This means your healthcare provider is responsible for providing the information you need to make a decision.

Even so, evaluating MS treatment options can feel overwhelming. In this article, you will learn what questions to ask your healthcare provider when switching MS medications, how the effectiveness of MS medications is determined, what to do after a relapse, and how to weigh the pros and cons of each medication.

Switching MS Medications: Questions to Ask Your Provider 

When talking to a healthcare provider about switching MS medications, consider asking questions about the following factors.

Length of Treatment 

While DMTs are meant to be used long term, each medication has a treatment schedule. Some DMTs like Aubagio (teriflunomide) are oral drugs taken once a day. Others are injectables that have their own schedules. For example, Avonex (interferon beta-1a)  is injected once a week.

Some medications, like Tysabri (natalizumab), are given as monthly infusions at a healthcare facility.

Ask your healthcare provider about the length of treatment and consider how each treatment type would fit in with your lifestyle. Some people may prefer taking a once-daily pill vs. going to a healthcare facility regularly.

Treatment Types

DMTs for MS are given in three ways: oral, injectable, and infusion therapies. Ask your healthcare provider about the benefits and drawbacks of each.

Discuss what type of treatment fits best with your daily activities so that you can take the medication as provided. Adherence to a medication schedule is important for it to be effective.

Consider your lifestyle when looking at each type of treatment. If you travel often, a monthly infusion may be difficult.

Side Effects

Like all medications, DMTs have side effects. These side effects range from mild to severe. The balance is finding a medication that provides the greatest benefit with the fewest side effects.

Ask your healthcare provider about common and rare side effects of the medication you’re considering. Your healthcare provider may also discuss your medical history and look at your reactions to previous medications to help find the one with the most benefits and fewest side effects.

Some newer MS medications may carry a higher risk of adverse reactions such as progressive multifocal leukoencephalopathy (damage to the brain by a virus), or serious effects on the heart. Ask your healthcare provider about the more serious effects each medication can have.

Pseudo-Exacerbations 

If you are experiencing an increase of symptoms, it’s important to be evaluated by your healthcare provider. It is possible that the increase in symptoms is a pseudo-exacerbation.

A pseudo-exacerbation is an increase in symptoms caused by something other than MS. It is not a true progression of the disease or relapse since it does not cause changes that can be viewed on an MRI.

If you are considering changing medications based on the fact that your current medication is not working, ask your healthcare provider if more tests are needed to confirm that your increase in symptoms is not due to a pseudo-exacerbation.

Insurance Coverage and Out-of-Pocket Costs 

MS medications can be quite expensive. The median price for DMTs as of February 2022 was $94,000 per year.

In an effort to keep costs down, some insurance plans require step therapy, in which you can only progress to the next drug if the previous one fails to work. Some insurance plans cover only certain drugs. If you change insurance providers or plans, you may need to switch medication.

Many brand-name drugs have patient assistance programs that can help with the cost.

Ask your healthcare provider about the cost of medication, whether your insurance will approve the medication. and, if not, whether there are patient assistance programs through the drug company.

Drug Interactions 

MS drugs, like all medications, can interact with other drugs and supplements, causing adverse reactions.

Ask your healthcare provider if the DMT will interact with any other prescription and over-the-counter (OTC) drugs you take regularly.

Before starting a supplement or other complementary therapy like cannabis, ask your healthcare provider if there are known interactions between the DMT and these supplemental therapies.

DMTs and Pregnancy 

If you and your partner are planning to conceive or you become pregnant while taking a DMT, it is important to talk to your healthcare provider about DMT use. Some DMTs can affect both eggs and sperm before conception, and some are known to be harmful to pregnancy.

Ask your healthcare provider about timing. Some DMTs should be stopped well before conception, while other DMTs can be taken during the first trimester or throughout pregnancy. There is a careful balance between protecting the person with MS and the developing fetus.

Immunization Safety 

There are many different types of vaccines. Live vaccines like the measles-mumps-rubella (MMR) vaccine are contraindicated for people on DMTs, which can weaken the immune system, making you more open to infection. The use of DMTs can also affect the effectiveness of some vaccines.

Before receiving a vaccine while taking a DMT, it is important to ask your healthcare provider about the safety and effectiveness of the vaccine.

How Specialists Assess MS Medication Effectiveness

The effectiveness of MS medication is based on disease activity. Low to no disease activity indicates an effective medication. Disease activity is measured through three factors: clinical relapses, activity on an MRI that shows new or active lesions, and an assessment of physical disease progression measured by a disability scale.

Next Steps After an MS Relapse 

The goal after an MS relapse is to return to your baseline of health and prevent further disease activity. A relapse can cause physical and cognitive symptoms that may linger for a while.

Your healthcare provider may prescribe treatment such as corticosteroids to address a relapse symptom such as optic neuritis (damage due to swelling of the eye's optic nerve).

Your provider may also evaluate disease activity with an MRI to assess the effectiveness of your current treatment.

Tips for Weighing MS Meds' Pros and Cons

There is a lot to consider concerning MS medications. Not every medication will be right for every person. MS is a lifelong condition that will evolve over time. Sometimes it helps to take a step back and look at the full picture when making a decision.

You may wish to consider:

• Are you planning a pregnancy? Some DMTs may not be compatible.
• Are you experiencing minimal disease activity or a lot of activity? Certain DMTs are more aggressive than others.
• What kind of side effects are you willing to tolerate?
• What kind of commitment are you able to make towards adhering to the treatment?
• Do you have preferences or qualms about oral, injectable, or infused medications? If you are completely afraid of needles, an injectable might not be the right choice.

Summary

There is much to consider when contemplating a switch in MS medications—efficacy, cost, side effects, effect on life changes such as pregnancy, vaccine safety, and interactions with other drugs. A healthcare provider can assess the efficacy of the medication, answer questions, and provide guidance.

A Word From Verywell

Deciding on the correct treatment plan for your MS can feel daunting, especially if you’ve already had to make a decision once before. Some people find that researching their options and writing down their questions and concerns can get them the help and information they need from their healthcare provider.

A drug that is right for you today might not be right for you tomorrow. The silver lining is that in the future, there may be a completely new drug on the market that might be an even better fit.