Choosing the best disease-modifying therapy (DMT) to treat your multiple sclerosis (MS) can be a tough 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 United States until the 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 find a good fit.
The Barts-MS tool
With input from several people with MS, neurologists at Barts and the London School of Medicine and Dentistry created in 2021 what I believe to be the first online DMT screening tool. It lists 13 DMTs. Users can select which DMTs to compare and the tool will narrow the list based on factors such as importance of preventing relapse or long-term disability, concerns about long-term or minor side effects, and whether a patient is willing to visit a health facility. to receive treatment or tests. The tool then issues a list that classifies the DMTs according to this criterion.
Surprisingly, the tool doesn’t ask users if they want to exclude a specific type of DMT based on delivery method, such as via injection, infusion, or pill. An article on the MS-Blog explains that this is because some of the most effective DMTs can only be delivered by one method, and the designers of the tool did not 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 about long-term side effects, and a few other things.
I think the tool did a good job generating its list, offering Tysabri, Lemtrada, and Ocrevus at the top. The first two were actually my most favorite treatments when treated with DMTs, and Ocrevus is the one I would have considered.
The MS Society UK Tool
The MS Society UK recently launched a similar tool on their website, with 18 DMTs. The tool narrows the list based on similar questions as the Barts tool. Unlike Barts, however, this tool asks if users would be willing to self-inject or receive an infusion.
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. Additionally, the tool only works if users indicate that they live in the UK, Isle of Man or the Channel Islands.
I pretended that I lived in the UK and had RRMS. Interestingly, the results do not list any of the DMTs I have ever been treated with. Instead, the tool selected Ocrevus and Kesimpta (ofatumumab), two highly effective treatments. It listed general reasons for the choices and provided a list of possible minor side effects for each. Then he suggested nearly all of the other 16 DMTs on the site, saying “they might be worth talking to your neurologist about.”
Fact sheets
One of the newest DMT decision tools comes in the form of information cards, a project by Professor Gavin Giovannoni, Barts Professor of Neurology and the London School of Medicine and Dentistry, and the medical student Safiya Zaloum.
Each card contains comprehensive information about a specific DMT written in easy to understand language. DMTs are scored on a scale of 1 to 10 based on attributes such as the ability to prevent relapse and progression, possible side effects, and family planning considerations. Unlike the two website tools, the maps include off-label MS drugs.
As Giovannoni describes the process on his MS-Selfie blog, a medical professional selects multiple cards for the most relevant DMTs for a patient. The patient then takes the cards home “to research further and make an informed decision.”
An example of a DMT selection map. (Courtesy of Gavin Giovannoni)
This project is still ongoing, and Giovannoni said he would like feedback on the maps from people with MS.
It’s a collaboration
Whether you use a website or a bunch of maps, however you choose a DMT, it really should be a collaboration between you and your neurologist. I hope this information will improve this collaboration. I also invite you to visit my personal blog at www.themswire.com.
Did you find this column useful? Share your opinion in the comments below.
Note: Multiple Sclerosis News Today is strictly a disease news and information website. It does not provide medical advice, diagnosis or treatment. This content is not intended to replace professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of anything you 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 stimulate discussion of issues relating to multiple sclerosis.