Medication can help to get MS symptoms under control and can reduce relapse rates and slow disease progression.
There is no disputing the essential role of personalised medication in treating and managing MS. Every person living with MS should have access to clear information about medication so they can make informed choices about both disease-modification and symptom management. They should also have regular opportunities to discuss, review, tailor and optimise medications for both disease progression and symptoms. This is critical to making sure that each person with MS has the best possible outcomes and quality of life.
The evidence for how lifestyle modification helps to slow disease progression and manage symptoms is also clear. Bringing together positive lifestyle choices with optimised medication and appropriate therapies can make the biggest combined difference in reducing the impact of MS, and optimising quality of life.
There are three main types of medication use in MS: to slow progression of MS, to manage the symptoms of MS like mood, pain, bladder problems, or spasticity, and to reduce the impact of a relapse.
Disease-modifying therapies (DMTs) are the medications designed to slow the progression on MS. There are lots of different types, and more are being developed all the time.
The type of MS you have, where and how you would like to have your treatment, how often you are happy to have it, the side-effects you can tolerate, and how ‘hard-hitting’ you want the treatment to be will all affect which DMTs might be best for you.
There are a number of excellent decision-making tools available, each with a different approach (Table 1)
Table 1: Decision-making tools
|
The tool |
Best for… |
When to use it |
Where to find it |
|
The MS Society DMT decision tool |
Initial ‘whittling down’ of options and practical preferences |
Pre-clinic for an initial understanding of the range of treatments and the way they can interact with daily life
|
|
|
Disease modifying therapies (DMT) comparison tool from Barts-MS |
Providing a clear, exportable record of decisions and preferences at the time |
For first discussions in face to face or remote clinics to work through alongside the patient. |
https://clinicspeak.com/dmt/ |
|
MS decisions aid from the MS Trust |
Helping someone to consolidate their views and reach a final decision after other discussions |
In a follow-up clinic or telephone call after initial discussions |
Regularly looking at medication choices, and whether things have changed in a persons’ life that might mean they want to make different choices, is really important. UK guidance from the National Institute of Health and Care (NICE 2022) states that every person with MS is entitled to a comprehensive review every year. This looks at everything to do with their MS and how it impacts their life. They are also entitled to an annual medication review, which looks at all medications they are taking and how they are working, every year.
Medication reviews can be about stopping medications, starting them, or changing them. They should look at medications you might be taking for something other than your MS, to make sure different medicines are not reacting with each other. They will also find out if you are taking any medications that could be making other symptoms worse, and help you make informed choices about what your priorities are.
If you want to talk about medication, or think you need to have review of the medications you are taking to make sure you are managing your MS as well as possible, you can ask your MS team, specialist nurse, or neurologist.
