Medication for MS

Medication can help to get MS symptoms under control and can reduce relapse rates and slow disease progression.

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What’s the role of medication in multiple sclerosis?

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.

Medication Decision Making Tools

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 a group of medications designed to reduce the number of relapses you might experience, and some can slow the progression of 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	https://dmt-tool.mssociety.org.uk/
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	MS decisions aid

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 healthcare professional team, specialist nurse, or neurologist.

What to consider when choosing your MS Medication

Don’t rush your decision. MS management is a long-term proposition, and there is usually time to make this important decision after careful reflection.
Read widely about the various options and listen to what others have experienced with a particular medication.
Consider changing a medication if it is not working, or if the side effects are too difficult to tolerate.
Have a conversation with your MS team about stopping a drug, as well as starting it, before starting any medication.
Consider medication choices with regard to fertility and pregnancy. Familiarise yourself with medication advice specific to the pre-conception, antenatal and post-partum stages of motherhood.
Choose carefully based on risk vs. benefit. The higher the reduction in relapse rate and disability progression risk, the more likely it is that side effects will be serious.
Understand the delivery method – you may need to attend hospital appointments, or you may be able to take pills or self-inject at home.
Very active or aggressive disease may require more potent medication with potentially more serious side effects.

MS medication options

Access to MS treatments can vary depending on the country you live in and healthcare systems. Each country has its own rules about which disease-modifying therapies (DMTs) are available and who can receive them.

All DMTs also come with potential risks and side effects, which will be different for each individual. It’s important for people with MS to talk to their MS team about the benefits and risks of each option so they can find the treatment that’s right for them.

You may also see these medications referred to as DMDs – disease modifying drugs.

The table below shows Disease Modifying Therapies (DMTs) for MS approved by the United States Federal Drug Administration (FDA) and the UK’s Medicines and Healthcare products Regulatory Agency (MHRA).

Generic drug name	Brand name (s)	How the treatment is given	Licensed for people with…	Level of efficacy
Alemtuzumab	Lemtrada	Infusion	Relapsing MS	HIGH
Cladribine	Mavenclad	Oral	Relapsing MS Secondary Progressive MS	GOOD
Dimethyl fumarate	Tecfidera	Oral	Relapsing MS	GOOD
Diroximel fumarate	Vumerity	Oral	Relapsing MS	GOOD
Fingolimod	Gilenya, Tascenso ODT	Oral	Relapsing MS	GOOD
Glatiramer acetate	Brabio Copaxone Glatopa	Injection	Relapsing MS	MODERATE
Interferon beta-1a	Avonex, Rebif	Injection	Relapsing MS	MODERATE
Interferon beta-1b	Betaferon Betaseron Extavia	Injection	Relapsing MS	MODERATE
Monomethyl fumurate	Bafiertam	Oral	Relapsing MS	GOOD
Natalizumab	Tyruko Tysabri	Infusion, injection	Relapsing MS	HIGH
Ocrelizumab	Ocrevus	Infusion	Relapsing MS Primary Progressive MS	GOOD
Ofatumumab	Kesimpta	Injection	Relapsing MS	HIGH
Ozanimod	Zeposia	Oral	Relapsing MS	GOOD
Peginteferon beta-1a	Plegridy	Injection	Relapsing MS	MODERATE
Ponesimod	Ponvory	Oral	Relapsing MS	GOOD
Siponimod	Mayzent	Oral	Relapsing MS Secondary Progressive MS	GOOD
Teriflunomide	Aubagio	Oral	Relapsing MS	MODERATE
Ublituximab	Briumvi	Infusion	Relapsing MS	HIGH

Exploring medications and treatment with our community

If you’re thinking of investigating your medication options with your healthcare professional why not ask our expert facilitators and Overcoming MS community first to get first-hand details of the pros and cons of each of your potential choices? You can join our community on our free platform the Live Well Hub.

As time with your nurse, GP or neurologist can be limited, it is recommended to optimise your time with them by heading in prepared (check out this podcast with Dr Aaron Boster on how to get the most out of your time).

We also have the following Overcoming MS events and courses:

Discover Overcoming MS
This short 1-hour online session is ideal for newly diagnosed people or those who are new to the Overcoming MS Program. We run one every two months and it’s a great space to not only hear about the basics of the Program but also to ask your own questions direct to our staff.
Pathway to Overcoming MS
If you’re ready to make lifestyle changes, this course is the perfect next step. Whether you’re relatively new to the Program, seeking to deepen your understanding or looking for renewed motivation, this free 8-week course offers expert guidance, practical tools, and a supportive community to help you succeed.
Overcoming MS Retreats
Our three-day residential retreats offer a unique opportunity to immerse yourself in a supportive environment and gain practical tools and knowledge to start making meaningful changes in your life.