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Disease Modifying Treatments (DMTs) for RRMS change how people’s immune system cells work. Studies show people taking DMTs have fewer relapses, and more time free from disability, than people who do not take DMTs [12, 19-27]. MS professionals plan with people how best to start, switch or stop treatment. The best chance of living without a long term disability is for people with RRMS to talk with their MS professionals about taking a DMT option. When the RRMS moves into an active stage, people can start having a DMT option.
The three types of DMTs work in different ways to delay people’s RRMS from getting worse:
| Immune Modulation Options | Immune Reconstitution Options | Immune Blocking Options | |
|---|---|---|---|
| Chemical Names of Treatments | Beta-interferons, Glatiramer Acetate, Dimethyl-fumarate, Teriflunomide. | Cladribine, Ocrelizumab and Alemtuzumab. | Fingolimod and Natalizumab. |
| How DMTs work | Change how cells work. Cells are less able to damage nerves. | Change the number of cells. Fewer cells can damage nerves. Other cells less able to damage nerves | Change how cells move in body. Nerve-damaging cells stopped from getting into the blood or moving into brain |
| Where taken | All types at home or place of choice. | Cladribine at home or place of choice. Ocrelizumab/Alemtuzumab at a day clinic | Fingolimod at home or place of choice. Natalizumab at a day clinic |
| Monitoring | Usual MS care | Regular blood tests in some and usual MS care | Regular blood tests and usual MS care |
| Health impact | Chance less likely to get relapses and disability. Chance of more side-effects and long-term health problems | Chance less likely to get relapses and disability. Chance of more side-effects and long-term health problems | Chance less likely to get relapses and disability. Chance of more side-effects and long-term health problems |
| Pregnancy | Glatimer Acetate for pregnancy. Glatimer Acetate and Beta-interferons for breastfeeding. | Talk with the MS team | Talk with the MS team |
Some people may have medical reasons why one type of DMT works better for them than another. In time, some people switch to a different DMT option because it is not working, or they are having new side-effects. Some people may stop taking DMTs when deciding to have a baby, or if they have another health problem [14, 21-23].
Each person with RRMS has a different experience of their disease, the symptoms they get, the number of relapses they have, and how quickly their RRMS changes.
For many people with RRMS, taking a DMT means they have fewer, or no, relapses. For some people taking a DMT, their RRMS may still worsen. All DMTs have a chance of side-effects and long-term health problems.
People taking DMTs will fit an extra medication routine into their lives, even if they do not have RRMS symptoms. Until people start taking a DMT, they cannot know if it will work for them, if they will get a side-effect, which one they may get, or how severe it may be.
Ask your MS Team if there are any new treatments they want to discuss with you; and how the Covid-19 pandemic affects you and your treatment decisions.
MS services are guided by advice from national health organisations about which treatments to offer, and when, for people at different stages of their RRMS [19-23]. Not all MS services offer all types of DMT options to people with all RRMS stages, and can signpost people to get other treatments from another MS centre.
This website used medical studies for facts about MS and DMTs [25, 26]. Different studies tested treatments in different ways and collected different facts. People taking part in these studies were chosen for different reasons based on their characteristics such as age, sex, length of having RRMS, treatments, and other health problems. These types of studies mean facts are not known for how well a DMT works in people with other characteristics. These fact-gaps mean figures cannot be calculated for all treatments about how well they work or the chance of side effects and health problems. Ask your MS team if there are new facts about how a treatment may work for you.
This table summarises facts about each treatment to help you compare what is similar and different. People find it useful to ask MS professionals questions about if and how these treatments may change something about their everyday life [15, 27], for example:
| Disease modifying treatment [type & brand name] | Number of relapses in a group of 100 people taking DMT in a year | Side-effects that often go away; about 10% (100 in 1000) of people get... | Long-term or life-threatening problems that usually need treating |
|---|---|---|---|
| Immune Modulation | |||
|
BETA-INTERFERONS Avonex - self-injection once a week Extavia - self-injection twice a week Plegridy - self-injection once every two weeks Rebif - self-injection three times a week |
35 relapses | For a few days after each dose: flu, skin reaction from injection, stomach upset |
Less blood cells to fight infection - up to 10% (100 in 1000) of people Liver, kidney problems - up to 10% (100 in 1000) of people None life-threatening |
|
DIMETHYL FUMARATE Tecfidera - pill twice a day |
24 relapses | For a few weeks or months: flushes, stomach upset, itchy skin |
Less blood cells to fight infection - up to 10% (100 in 1000) of people Kidney and liver problems – up to 10% (100 in 1000) of people Rare chance of life-threatening brain infection (progressive multifocal leukoencephalopathy: PML) – not enough people to work out figures |
| GLATIRAMER ACETATE Copaxone & Brabio - self-injection 3 times a week |
35 relapses |
Immediately, then goes away: flushes, chest tightness, palpitations Later: stomach upset, back pain, low blood pressure, skin reaction from injection |
Skin damage in injection areas – more than 2% (20 in 1000) of people Liver problems - up to 10% (100 in 1000) of people None life-threatening |
| TERIFLUNOMIDE Aubagio - pill once a day |
36 relapses | For a few months: flu, headache, stomach upset, urine and chest infections |
Anaemia – up to 10% (100 in 1000) of people Liver problems - up to 10% (100 in 1000) of people Less blood cells to fight infection - up to 10% (100 in 1000) of people None life-threatening |
| Immune reconstitution | |||
| CLADRIBINE Mavenclad - pill for 10 days in years 1&2, then no pills if no relapses |
22 relapses | Rash, infections like shingles, cold sores | Less blood cells to fight infections - more than 10% (100 in 1000) of people Rare chance of tuberculosis, can be life-threatening – not enough people to work out figures. |
| OCRELIZUMAB Ocrevus - drip at hospital every six months |
19 relapses |
Immediately, then goes away: headache, rash, palpitations, feeling sick Later: infections like flu, stomach flu, cold sores |
Less blood cells to fight infections – more than 10% (100 in 1000) of people None life-threatening |
| ALEMTUZUMAB Lemtrada - drip at hospital for five days, then a year later for 3 days, then no treatment if no relapses |
16 relapses |
Immediately, then goes away: headache, rash, palpitations Later: infections like colds, flu, urine |
Less blood cells to fight infections - more than 10% (100 in 1000) of people Thyroid problems – about 37% (370 in 1000) of people Kidney problems - up to 0.1 % (1 in 1000) of people Chance of life-threatening problems: |
| Immune blocking | |||
| FINGOLIMOD Gilenya - pill daily |
24 relapses | Infections like shingles, cold sores, and flu, palpitations, benign skin cancer, headache, stomach upset |
Lower blood cells to fight infections- up to 1% (10 in 1000) of people Vision problems, blood clotting problems – up to 1% (10 in 1000) of people Chance of life-threatening problems: |
| NATALIZUMAB Tysabri - drip, half day every month | 16 relapses | Infections like throat, urine infections, stomach upset, headache | None that can be worked out. Chance of life-threatening problems: |