Choosing the best disease-modifying therapy (DMT) to treat your multiple sclerosis (MS) can be a difficult decision.
When I was diagnosed with MS in 1980, it was easy. There were no DMTs to choose from. The first three – Avonex (interferon beta-1a), Betaseron (interferon beta-1b), and Copaxone (glatiramer acetate injection) – were not approved in the US until the early to mid-1990s.
Today there are more than 20 DMTs on the market. The most recent, Briumvi (ublituximab), was approved by the US Food and Drug Administration last December. So how should a person with MS choose? One size doesn’t fit all, but there are tools that can help you find a good fit.
The Barts-MS tool
With input from several people living with MS, neurologists at Barts and The London School of Medicine and Dentistry created in 2021 what I believe is the first online DMT selection tool. It has 13 DMTs on it. Users can select which DMTs to compare, and the tool will narrow the list based on things like the importance of preventing relapses or long-term disability, concerns about long-term or minor side effects, and whether a patient is willing to visit a healthcare facility for treatment or to undergo tests. The tool then displays a list that ranks the DMTs based on these criteria.
Surprisingly, the tool doesn’t ask users if they want to rule out a specific type of DMT based on the method of administration, such as via injection, IV, or pill. A post on the MS-Blog explains this is because some of the most effective DMTs can only be delivered via one method, and the tool’s designers didn’t want to exclude them from the results.
As a test, I selected the four DMTs I was treated with – Avonex, Tysabri (natalizumab), Aubagio (teriflunomide), and Lemtrada (alemtuzumab) – along with Ocrevus (ocrelizumab). I also told the tool that preventing long-term disability was important to me, that I was moderately concerned with long-term side effects, and a few other things.
I think the tool did a good job generating its list, with Tysabri, Lemtrada, and Ocrevus at the top. The first two were actually the treatments I preferred most when being treated with DMTs, and Ocrevus is one I would have considered.
The MS Society UK tool
The MS Society UK recently launched a similar tool on its website, featuring 18 DMTs. The tool narrows the list based on questions similar to the Barts tool. However, unlike Barts, this tool asks if users are willing to self-inject or get an IV.
Unfortunately, the tool only offers a DMT selection if users select relapsing-remitting MS (RRMS). If the diagnosis is different, users are directed to a general DMT information page. The tool also only works if users indicate they live in the UK, the Isle of Man or the Channel Islands.
I pretended to live in the UK and have RRMS. Interestingly enough, the results didn’t mention any of the DMTs I’ve been treated with before. Instead, the tool selected Ocrevus and Kesimpta (ofatumumab), two highly effective treatments. It listed general reasons for the choices and listed possible minor side effects for each. It then suggested almost all of the other 16 DMTs on the site and said, “They might be worth talking to your neurologist about.”
Information cards
One of the latest DMT decision tools comes in the form of information cards, a project by Professor Gavin Giovannoni, chair of neurology at Barts and The London School of Medicine and Dentistry, and medical student Safiya Zaloum.
Each card contains comprehensive information about a specific DMT, written in easy-to-understand language. The DMTs are scored on a scale of 1-10 based on characteristics such as ability to prevent relapse and progression, potential side effects, and family planning considerations. Unlike the two website tools, the cards contain medications used off-label for MS.
As Giovannoni describes the process on his MS-Selfie blog, a healthcare provider selects different cards for the DMTs most relevant to a patient. The patient then takes the cards home “to conduct further research and make an informed decision.”
An example of a DMT selection map. (Courtesy of Gavin Giovannoni)
This project is still a work in progress, and Giovannoni said he would like comments on the maps of people with MS.
It’s a collaboration
Whether you use a website or a bunch of maps, no matter how you choose a DMT, it really should be a collaboration between you and your neurologist. I hope this information will make that cooperation better. I also invite you to visit my personal blog at www.themswire.com.
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Note: Multiple Sclerosis News Today is exclusively a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended as a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health care professional if you have any questions about a medical condition. Never disregard professional medical advice or delay your search because of something you have read on this website. The views expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews, and are intended to promote discussion of issues related to multiple sclerosis.