3 tools to help you choose the right MS disease-modifying therapy

With over 20 DMTs on the market, picking the right one can be a daunting task

Ed Tobias avatar

by Ed Tobias |

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Choosing the best disease-modifying therapy (DMT) to treat your multiple sclerosis (MS) can be a tough decision. 

When I was diagnosed with MS way back 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) — weren’t approved in the U.S. 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 U.S. Food and Drug Administration last December. So how’s a person with MS to 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 selection tool. It lists 13 DMTs. 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 to receive treatments or tests. The tool then issues a list that ranks the DMTs based on this criteria.

Surprisingly, the tool doesn’t ask users whether they want to rule out a specific type of DMT based on the delivery method, such as via a shot, an infusion, or a pill. A post on the MS-Blog explains that this is because some of the most effective DMTs can only be delivered via a single method, and the tool’s designers didn’t want to exclude them from the results.

As a test, I selected the four DMTs I’ve been treated with — Avonex, Tysabri (natalizumab), Aubagio (teriflunomide), and Lemtrada (alemtuzumab) — along with Ocrevus (ocrelizumab). I also told the tool that prevention of 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, offering Tysabri, Lemtrada, and Ocrevus at the top. The first two were actually the treatments I preferred most when I was treated with DMTs, and Ocrevus is one I would have considered.

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The MS Society UK tool

The MS Society UK recently launched a similar tool on its website, with 18 DMTs. The tool narrows the list based on similar questions as the Barts tool. Unlike Barts, however, this tool asks whether 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. Also, the tool only works if users indicate they live in the U.K., Isle of Man, or the Channel Islands. 

I pretended I lived in the U.K. and had RRMS. Interestingly, the results didn’t list any of the DMTs I’ve previously 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 it suggested nearly all of the other 16 DMTs on the site, saying “they might be worth talking to your neurologist about.”

Information cards

One of the newest 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 1-10 scale based on attributes such as the ability to prevent relapses and progression, possible side effects, and family planning considerations. Unlike the two website tools, the cards include medications that are used off-label for MS.

As Giovannoni describes the process on his MS-Selfie blog, a healthcare provider selects several cards for the DMTs most relevant for a patient. The patient then takes the cards home “to further research and make a guided decision.”

A screenshot of a digital flashcard displaying information about the medication natalizumab, along with a rating score.

A sample DMT selection card. (Courtesy of Gavin Giovannoni)

This project is still a work in progress, and Giovannoni said he would like comments on the cards from people with MS. 

It’s a collaboration

Whether you’re using a website or a bunch of cards, no matter how you go about selecting a DMT, it really needs to be a collaboration between you and your neurologist. I hope this information will make that collaboration better. I also invite you to visit my personal blog at www.themswire.com.

Did you find this column helpful? Share your thoughts in the comments below. 


Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to multiple sclerosis.

Comments

Poul Hansen avatar

Poul Hansen

I am a resident of Denmark, diagnosed in 2009 with PPMS at the age of 60, now I am 73 years old, male. I receive no medication except Fampyra. I am told to be too old for being treated with Ocrevus. Is that the same for USA?

Reply
Ed Tobias avatar

Ed Tobias

Hi Poul,

Unfortunately, it sometimes is the same. It really depends on the neurologist. Some will prescribe a disease-modifying treatment, such as Ocrevus, for an older patient but many will not. I began treatment with Lemtrada when I was 68. I'm not sure, however, if it would still be appropriate for me now that I'm 74 and, frankly, I'm not sure that I would be able to handle the potential side-effects now.

Ed

Reply
Reginald E Bavis avatar

Reginald E Bavis

I have MS diagnosed in 1995 with secondary progressive and have a Doctor that does not seem to keep up to date with the new technology what do you propose I do , I now get around with the use of a scooter Reg Bavis

Reply
Ed Tobias avatar

Ed Tobias

Hi Reg,

I'm sorry to hear that. Is it possible for you to find a different doctor?

Ed

Reply
Claire Winchester avatar

Claire Winchester

Hi Ed,
Just wanted to let you know that the MS Trust has actually had an online DMT choosing tool since 2015. Surprised you haven't found it in your research!

Our tool, MS Decisions, began as a project at the National Hospital for Neurology and Neurosurgery back when there were just the injectables available. It's been extensively revised and updated over the years, involving MS specialists and people with MS at all stages, and has recently been rebuilt to be fully accessible on all devices. It is complemented by our print versions too, including a handy fold out chart.

Much copied, but we think still a vital resource for shared decision making. I'd be delighted to tell you all about it!

https://mstrust.org.uk/ms-decisions
https://mstrust.org.uk/information-support/ms-drugs-treatments/ms-decisions

Dr Claire Winchester
Head of Information and Engagement
MS Trust

Reply
Ed Tobias avatar

Ed Tobias

Hi Dr. Winchester,

I'm so sorry I missed your the MS Trust's selection tool but thanks for providing a like to it here. Also, I'm updating "The Multiple Sclerosis Toolbox," a little book that I wrote a little over a year ago for MS "newbies," and I'll be sure to include it in my chapter on choosing a DMT. (The MS Trust website is already on my list of suggested internet resources.)

Regards,

Ed

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