Medications, Therapies, and MS
The decision to start therapy is a very personal one. MS is a chronic condition and you will need to take your medication for the foreseeable future. So you will have to commit to therapy and incorporate any new treatments into your lifestyle.
How do MS medications work?
As recently as a decade ago, people with MS had no treatment options—no effective medications were available. That changed with the introduction of the first disease-modifying therapies (DMT). These medications target the immune system in different ways to reduce the frequency and severity of relapses.
What DMTs do?
During an immune reaction, specialized cells called T-cells become activated. T-cells then migrate to the blood-brain barrier (BBB), a layer of densely-packed cells that normally controls the passage of substances into the central nervous system. The T-cells adhere to the BBB, work their way across the barrier, and enter the brain and spinal cord. Once inside the central nervous system, the activated T-cells stimulate inflammation that results in lesions (plaques), demyelination, and axonal damage.
Each of these events is like a link in a chain. What DMTs do is target different mechanisms to interrupt the chain of events and reduce inflammation and damage.
All of the DMTs modify the MS disease process and reduce the frequency of relapses; some may also reduce the severity of the attacks when they do happen.
Preventing inflammatory relapses from occurring is important. It’s also important to slow down the unseen nerve damage that will result in disability over the longer term. Some studies have also suggested that regular treatment will slow disease progression, however no long-term controlled studies have been done, so it isn’t known if the chances of disability down the road are less for people taking an MS medication.
DMTs aren’t a cure. They’re more like a preventive therapy (like a vaccine) and are meant to protect you from developing problems in the future.
Should you start treatment?
There are currently (Fall 2013) eight disease-modifying therapies approved by Health Canada. Five of these medications Avonex®, Betaseron®, Extavia®,Copaxone® and Rebif® — are immune modulating medications.
The sixth —Tysabri® —a selective adhesion molecule inhibitor is another option but is considered a second-line treatment because it is generally reserved for people who have not responded adequately to other disease-modifying therapies or who are unable to tolerate them. This is because of the potentially severe side effects that can develop with Tysabri.
The seventh —Gilenya® — is the first oral treatment for MS and a new class of treatment called a sphingosine 1-phosphate receptor modulator. It is thought to preserve key immune functions and is taken as a daily pill. Like Tysabri, Gilenya is also a second-line treatment.
The eighth, Tecfidera TM is a first-line oral treatment for adults aged 18 and older with relapsing-remitting MS.
Immediate treatment is recommended because of the growing body of scientific evidence that inflammation, demyelination, and axonal loss begin very early in the MS disease process. This means that long before you had your first symptom, MS was causing damage to your central nervous system. For many people, MS is only diagnosed years later, when the effects of the disease become more obvious. Once it’s confirmed that you have MS, it’s important to start treatment early to give your body a better chance of fighting the MS disease process and preventing any further damage.
Treatment won’t be the best option for everyone. DMTs are most effective in people with relapsing-remitting MS; they are not effective for those with primary-progressive disease. Tell your doctor if you’re planning to become pregnant because that will also affect whether or not you should start treatment.
How do you decide?
When you ask yourself the treatment question, keep in mind that there isn’t one solution that’s right for everyone. The decision to start treatment is very personal, and you’ll need to discuss the matter very carefully with your neurologist. The first step is to gather all the information you can so any decision you make will be an informed one. The best sources of information are your neurologist, the MS clinic, and the MS Society. The internet can be invaluable if you access legitimate medical or patient websites, or MS Society sites like this one. (Beware of sites that are trying to sell you something: if the claims sound too good to be true, they probably are.) DMT manufacturers also have websites and toll-free help lines with information about their specific products.
The amount of information can be overwhelming so give yourself some time to digest what you’ve learned. Then book an appointment with your neurologist to discuss whether starting treatment right away is the best option for you. Ask lots of questions, and make sure you understand everything your doctor tells you before moving forward.
It can be helpful to write down your questions beforehand. Here are a few to get you started:
- What can I expect a medication to do for me?
- What won’t it do?
- What side effects can I expect?
- Are there any reasons why I shouldn’t be taking a specific medication?
- When I start therapy, how soon will I start to feel better?
- Will a medication affect my lifestyle?
- Are there any important differences among the medications?
- How will I learn to inject myself?
The decision to start taking a medication can feel like a burden, but you don’t have to shoulder it alone. Share any doubts or fears you might have with your family and friends. The MS Society can also put you in touch with other people in your community who are living with MS. And check the message boards right here on this website to find other young people facing the same issues you are.
An MS therapy will only be effective if you take it regularly, so you will need to commit to taking your medication for the rest of your life. That may seem difficult and time-consuming. But remember that therapy isn’t costing you time: in fact, the hope is that it will buy you time.
What about treatments for relapses?
Relapses are often treated with steroid-type drugs such as prednisone or intravenous methylprednisolone, to reduce the severity of an individual attack of MS and speed up recovery from it, particularly in the earlier stages of the disease. The steroids (also called corticosteroids) work by reducing the inflammation that occurs in the central nervous system during a relapse. They are of no value during the later progressive stages and may even produce harmful side effects. Long-term use should be avoided.