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What are your treatment options?

What are your treatment options?

What are your treatment options?

Although MS cannot currently be cured, there are a growing number of MS therapies to manage and slow progression of the disease.[1]

Treatments are broadly separated into three categories: disease-modifying therapies, treatments for relapses and treatments for specific symptoms.[2]

Each treatment is designed to make living with MS more manageable, so you can enjoy a better quality of life. But, as with all medicines, there may be side effects that must be taken into account when determining how your disease can best be managed. That’s why it’s essential to first understand which treatment options are available to you, but also the benefits and drawbacks of each treatment to see how they can fit in with your life.

Choosing your MS treatment should be personalised based on your preferences and needs and can, if you choose, involve shared decision-making between you and your healthcare team. By co-creating a treatment plan that best suits your life-situation and life priorities, you are more likely to follow it and feel the full benefits of your treatment(s).[2]

Explore the options below to learn more.

Disease-modifying therapies (DMTs):

DMTs aim to help reduce the number and severity of relapses, limit the number of central nervous system lesions (such as in the brain and spinal cord), and slow disease progression.[3]

Benefits
Treatment considerations
Benefits
  • DMTs can be used from the beginning of your MS journey and onward[4]
  • It can be helpful to start the right DMT as early as possible to manage your MS better[4]
Treatment considerations
  • How you experience MS, including physical and mental/cognitive symptoms, and the level of disease activity[5]
  • Short and long-term life priorities such as whether you like remote or extended holidays or if you travel a lot for work, or if you are looking to start a family (now or in the future)?[5]
  • How well the DMT will work to manage your MS, possible side effects, and how it interacts with other medicines or health conditions[5]
  • Practical considerations such as how they are administered or stored[5]

Treatments for relapses:

A common treatment for relapses is using steroids, also known as corticosteroids, a type of anti-inflammatory medicine. Steroids aim to reduce inflammation and speed up recovery if you have an acute relapse.[1]

Your healthcare team may also offer non-medicinal treatments, such as rehabilitation after a relapse. This may be provided alongside steroids or as the primary treatment option, depending on how severe your relapse is and how you choose to treat it.[6]

Benefits
Treatment considerations
Benefits
  • Steroids can shorten your MS relapse[6]
  • Some evidence suggests rehabilitation alongside steroids can improve your time to recovery from a relapse[6][7]
  • They can be used at any point throughout your MS journey when you are relapsing
Treatment considerations
  • The severity and duration of your relapse - not all relapses require treatments. For milder relapses, you may decide to have no treatment, but you should discuss this with your healthcare team[8]
  • Taking steroids can improve your relapse symptoms, but it won’t have a lasting impact on your long-term MS-related disability[8]
  • Side effects linked with short and long-term use of steroids include:[7]
    • Mood changes
    • Difficulty sleeping
    • Increased appetite

Treatments for specific symptoms:

You may be aware of the chronic symptoms of MS such as fatigue, visual problems, or heightened emotional states and the many life challenges that accompany these symptoms. Your healthcare team may advise certain medicines and non-medicine-based lifestyle changes, such as nutrition and rest, to help relieve the symptoms of MS.[5]

Benefits
Treatment considerations
Benefits
  • A mixture of medicines and lifestyle changes can significantly improve symptom management[5]
Treatment considerations
  • Which symptoms (physical, mental or ‘invisible’) are most disabling for you and are a priority for treatment[9]
  • How multiple medicines may (adversely) interact with each other or other health conditions that you may have[10]

Whether you’re just starting your treatment journey or switching medicines, there is a lot to consider.

You can work with your healthcare team to choose a treatment option best suited to your lifestyle and treatment goals. And remember, there is no one-size-fits-all; some treatments may serve you better than others, and your treatment may change over time depending on your symptoms and situation.[11][12]

How will my medicines be administered?

How the medicines are administered may influence the treatment approach you decide on. It’s good to have this information before deciding on your treatment plan, so be sure to discuss this with your healthcare team.[2]

Some of the most common methods include oral tablets (taken by mouth), intravenous infusion (also known as a ‘drip’) and/or through injections. Below is a summary of each, including which treatment approaches use them and some pros and cons you may wish to consider in your decision-making.[13]

Oral (taken by mouth)

A convenient option for most people living with MS, who can swallow tablets and remember to take medicine regularly.[13]

Which treatments typically use this method?

✓ Disease modifying therapies

✓ Treatments for relapses

  • Oral steroid

✓ Treatments for symptoms

  • Oral medicines for fatigue
  • Depression etc.
Pros
Cons
Pros
  • Relatively easy to take and fit into your routine[14]
  • Can be taken anywhere and discreetly
  • May only need to be taken once or twice a day, or only require short courses[3]
Cons
  • You may forget doses at times (and it’s important to follow the dosing timetable accurately to receive the treatment benefit)
  • Some medications may require you to follow a set dosing schedule when you start treatment to get to the daily dose (your healthcare professional can often give you a starter pack for this)[14]
  • May require you to take it with food or it may have food restrictions[14]

Injection

An option that comes in two forms for MS: subcutaneous (administered under the skin) or intramuscular (administered in the muscle).[11]

Which treatments typically use this method?

✓Disease modifying therapies (DMT)

Pros
Cons
Pros
  • Can be given by a healthcare professional in a healthcare setting, or at home by a care partner or yourself, depending on the DMT and local practices[15]
  • Typically taken less frequently than oral medications (depending on the medicine)[15]
Cons
  • You may have to inject yourself with a needle, which may be difficult to stick to if you have a fear of, or aversion to, needles
  • Those with certain medical conditions may be at a higher risk of getting infections at the injection site[4]
  • May require refrigeration, which can be a challenge when travelling[5]

Infusion

A medicine delivered directly into the bloodstream.

Which treatments typically use this method?

✓ Disease modifying therapies

✓ Treatments for relapses

e.g. intravenous steroid for acute relapse or when an oral steroid has been unsuccessful

Pros
Cons
Pros
  • Allows for a fast and precise amount of medicine to be administered[16]
  • Taken the least frequently of any DMT form (as little as 2 times per year)[3]
Cons
  • Requires you to travel to a hospital or treatment centre
  • Takes the most time to administer

Making an informed treatment choice

It's your life - how you take medicines and how they work will be important to you. Be sure to talk these points through with your healthcare team to help you make an informed choice about your treatment. Together, you can choose the treatment that works with your life today with an eye toward the future.[2]

Treatment-related questions to consider with your healthcare team

As you begin exploring your treatment options, you may already have several questions you wish to discuss with your healthcare team. Below are some questions you might ask to help guide this conversation.

Does the medicine come as a tablet, injection, or infusion? How often and for how long do I have to take it (daily, weekly, monthly, or every few months)?
What is the process of starting the treatment like, and do I think I will be able to continue taking it given my current lifestyle?
What if I need to pause my treatment, for example, if I want to become pregnant, or to receive certain vaccinations?
How do treatment options compare to one another?
How does the medication need to be stored? How long does it last?
Will the MS medication impact the treatment or symptoms of other conditions I may be suffering from? Is the treatment compatible with other medications I regularly use?
What do study results show? How well does the medicine manage my MS?
Are side effects common with the treatment option? What are the most common side effects?

These questions are specific to your treatment choice, but treatment choices are just one part of an ongoing discussion with your healthcare team. MS symptoms and how you experience them are also a big part of living your life with MS, and so you may also wish to prepare a list of questions specific to your MS symptoms

Talking to your doctor about your future plans and changing lifestyle needs

Choosing a treatment approach that suits your needs is critical in managing your MS. But your needs may change and flex over time. That’s why it’s important to consider all your options, but also recognise what works for you at one point in life may work less well for your needs in future. As a priority, your treatment choice should enable you to live your life to its fullest potential and not hold you back from achieving your goals.[2]

The decision to switch treatments is extremely personal to you and should follow an informed discussion between yourself and your healthcare team. However, switching treatments should be informed by the below factors:[4]

Side effects outweigh intended benefit

A desire to start planning a family now or in the future – not all medicines are suitable for people who are or plan to become pregnant

Managing new or existing health conditions (e.g., infections, certain vaccinations, and other medical conditions)

Issues with taking medicine(s) as directed

Facing further disease progression, such as experiencing a relapse, or other symptoms of MS

This might seem like a lot to think about – but remember your healthcare team are there to help guide you through your treatment choices. Take the time to share your personal plans and lifestyle with your healthcare professional. And remember, this conversation isn’t a fixed one-off; if something changes, talk to them. The more information your healthcare team has, the better they can advise how treatments can be tailored to your needs.[2]

References

[1]
National Multiple Sclerosis Society. Medications. (Online). Available at: www.nationalmssociety.org/Treating-MS/Medications (accessed January 2023)
[2]
National Institute for Health and Care Excellence. Multiple sclerosis treatment summary. (Online). Available at: bnf.nice.org.uk/treatment-summary/multiple-sclerosis.html (accessed January 2023)
[3]
Disease-Modifying Therapies For Multiple Sclerosis. (Online). Available at: nms2cdn.azureedge.net/cmssite/nationalmssociety/media/msnationalfiles/brochures/brochure-the-ms-disease-modifying-medications.pdf (accessed January 2023)
[4]
De Angelis F, John N. Disease-modifying therapies for multiple sclerosis. British Medical Journal 2018;363: k4674. Available at: www.bmj.com/content/363/bmj.k4674
[5]
Multiple Sclerosis Trust. Guide to decision-making. (Online). Available at: www.mstrust.org.uk/about-ms/ms-treatments/ms-decisions/guide-decision-making (accessed January 2023)
[6]
National Multiple Sclerosis Society. Managing relapses. (Online). Available at: www.mssociety.org.uk/about-ms/types-of-ms/relapsing-remitting-ms/managing-relapses (accessed January 2023)
[7]
NHS. Steroids. (Online) Available at: www.nhs.uk/conditions/steroids. (accessed January 2023)
[8]
Multiple Sclerosis Trust. Steroids. (Online). Available at: mstrust.org.uk/a-z/steroids-methylprednisolone (accessed January 2023)
[9]
National Multiple Sclerosis Society. MS Signs & Symptoms. (Online). Available at: www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms (accessed January 2023)
[10]
Frahm, Hecker, et al. The risk of polypharmacy, comorbidities, and drug–drug interactions in women of childbearing age with multiple sclerosis. Therapeutic Adv in Neuro Dis, 2020;13. Available at: doi:10.1177/1756286420969501
[11]
Comi G, Radaelli M, Soelberg Sørensen P. Evolving concepts in the treatment of relapsing multiple sclerosis. Lancet. 2017;389;10076:1347-1356. Available at: http:10.1016/S0140-6736(16)32388-1
[12]
American Journal of Managed Care. Multiple Sclerosis: The Safety-Efficacy Balance and Preventing Neurodegeneration. (Online). Available at: www.ajmc.com/view/ms-the-safety-efficacy-balance-and-preventing-neurodegeneration (accessed January 2023)
[13]
Kim J., and De Jesus O., Medication Routes of Administration. National Library of Medicine, National Institutes of Health. (Online). Available at: www.ncbi.nlm.nih.gov/books/NBK568677 (accessed January 2023)
[14]
Le J, Drug Administration. Merck Manuals Consumer Version. 2022. (Online). Available at: www.merckmanuals.com/home/drugs/administration-and-kinetics-of-drugs/drug-administration (accessed January 2023)
[15]
Healthline. Oral vs injectable MS treatments: what’s the difference? (Online). Available at: www.healthline.com/health/multiple-sclerosis/oral-vs-injectable-ms-treatments#self-injectable-medications (accessed January 2023)
[16]
Clinical Procedures for Safer Patient Care. Chapter 7.5 Intravenous Medications by direct IV route epub. (Online). Available at: opentextbc.ca/clinicalskills/chapter/6-9-iv-main-and-mini-bag-medications (accessed January 2023)

Last updated February 16, 2023 — EM-116916 — Creation Date: January 2023

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