SECTION D: Making my Disease Modifying Treatment Decisions

When deciding whether or not to start taking a DMT, people find it useful to trade-off their reasons for or against one option compared with another. In the box below is an example of a trade-off you might make between the chances of managing your RRMS with the side-effects of new treatments.

Options	Reasons For	Reasons Against
Symptom & Relapse Take treatment when get symptoms.	Manage symptoms and relapse. No extra chance of getting a life-limiting illness.	No extra chance of getting fewer relapses or living longer without disability.
Disease Modifying Take medication long-term, even when no symptoms.	Chance of living longer without disability. Chance of fewer or less serious relapses.	Chance of getting another health problem. Chance of getting a life-threatening illness.

Given what you know about Symptom and Relapse Treatments and DMTs, on balance which of these statements best matches your view about managing your RRMS:

• Keep using Symptom & Relapse Treatments only to manage my RRMS
• Take Symptom & Relapse Treatments until my next RRMS relapse
• Plan to start taking a Disease Modifying Treatment

In Section C there were facts about each type of DMT and prompts to help you think about why one DMT might suit you better than another. You may find it useful to make trade-offs about the reasons for and against each DMT option when thinking about this decision. For example, which medication has:

• The best chance of slowing down my RRMS with the lowest chance of getting another health problem.
• The best chance of fitting into my life with the lowest effort needed to cope with any side-effects I may get.

Comparison DMT Table

Given what you know about DMTs now, select one option from each DMT group you want to talk about taking first with your MS health professionals.

Immune Modulation Options	Immune Reconstitution Options	Immune Blocking Options
Beta-interferons [brand names: Avonex, Extavia, Plegridy, Rebif]	Cladribine [brand name: Mavenclad]	Fingolimod [brand name: Gilenya]
Glatiramer Acetate [brand name: Copaxone, Brabio]	Ocrelizumab [brand name: Ocrevus]	Natalizumab [brand name: Tysabri]
Dimethyl-Fumerate [brand name: Tecfidera]	Alemtuzumab [brand name: Lemtrada]
Teriflunomide [brand name: Aubagio]

Use this space to note down points you want more facts about:

The lives and health of people with RRMS change in the same ways as those of people without RRMS. People in their 20s have different experiences, goals and needs than when they are in their 40s or 60s. Some people want to stop taking DMTs for a short time to get pregnant or have treatment for another health condition. Some people need to stop taking DMTs because their MS has worsened and/or the DMT is not working for them [14, 19-26]. Some DMTs need to be stopped slowly for the medication to leave a person’s body a little bit at a time. For some DMTs, stopping the medication too quickly can mean people have a relapse. The time taken from when a person stops taking a treatment to when the body is free of its chemicals is known as a washout period. Each DMT has a different wash out period.

Most people with RRMS taking a DMT will switch to another option over time. It can take up to six months before people know if a DMT option is working at its full strength. When people are deciding whether to keep or stop taking a DMT option, they are thinking about how their RRMS is changing, the effect of relapses on their health, the effect of the DMT on their longer-term health, their life plans, and the future plans of those people close to them.

The types of decisions people make are: change medication in same group of DMT types, change medication to one from a different DMT group, stop taking any DMT for a health-related reason.

Given what you know about taking a DMT, which of these statements best matches your view about your DMT decision

• Keep taking the same Disease Modifying Treatment option
• Plan to change my Disease Modifying Treatment option
• Plan to stop taking my Disease Modifying Treatment option