Brandon Beaber, MD, is a multiple sclerosis (MS) neurologist based in Southern California. He describes common misunderstandings that newly diagnosed people may believe about MS treatments, why those ideas seem reasonable, and how patients should reframe their thinking.

Well, the first thing is that the aggressiveness of treatment should be dependent on someone’s current level of disability. From my perspective, the optimal candidate for an aggressive treatment is someone who is younger, has relapsing MS, is a CEO, can run marathons … I’m just joking. But in general functioning, [they should be] well because the name of the game is preventing inflammation-related disability early in the disease.

It’s not that people who are older with more advanced MS can’t benefit from treatment. It’s just that there’s more opportunity if you are sort of higher functioning at baseline. Another misconception is some people kind of overestimate the risks of certain treatments. I know for a younger, healthy person, taking an immunosuppressive medication is extremely unsavory. I mean, obviously this was particularly true when COVID was bad. And don’t get me wrong: I’ve seen many people who had severe COVID and other severe infections [while] taking these immunosuppressants, [that were] caused by these immunosuppressants. But I think some people assume they have to dramatically change their lifestyle just because they’re taking these medications. And of course, it depends on the person, depends on the medication, depends on their age, their other comorbidities. But many people can learn, live a normal life and really aren’t having major side effects.

Another thing I would mention is that, let’s say a treatment is effective — people are doing well and they’re not having side effects — many people would think you have to continue that treatment forever. Now, that may not be true. With some of these stronger immunosuppressants, because of their risk profile, it may be better not to take them indefinitely long term. This is particularly true with certain medications, for instance, that work on depleting B lymphocytes. The risk may be low early on in the first few years, and that’s why they look good in clinical trials. But taking them long term, and other medications, could be quite risky. There’s this idea of de-escalation, getting the disease under control early and then reducing risk later on. Of course, it’s all dependent on the individual person and their specific circumstances.