How to Choose the Right Multiple Sclerosis Treatment With Your Doctor

There are short-term treatments to relieve MS flares and long-term treatments to prevent progression.

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“There are a lot of different factors to consider when choosing a multiple sclerosis (MS) medication,” says Asaff Harel, MD, Neurologist at Lenox Hill Hospital, Northwell Health. “With over 20 different options, 10 different classes of medications, it really requires an open dialogue between you and your physician.”

There are two key categories of medications. First, there are short-term treatments to relieve multiple sclerosis flares. Then, there are long-term treatments to slow or prevent progression of the condition. 

Each treatment has a different schedule, like every day, every month, or every six months. They could come as a pill, injectable, or infusion medication. Choosing which is best for you at any given moment of your journey will depend on a few factors.

How do you choose the right MS medication with your doctor?

When it comes to simply responding to and de-escalating flare ups, your treatment might include intravenous corticosteroids or plasma exchange.

For a more comprehensive, preventative strategy, your doctor will turn to disease-modifying treatments (DMARDs).

There are a few different types:

  1. Injections that you give yourself
  2. Infusions that you receive from an IV at an infusion center
  3. Oral treatments (pills) that you take regularly

There are pros and cons to each type. You may be able to choose which option is more convenient for you. Some people may only be eligible for one type and may not have as much of a choice.

Other factors you and your doctor will need to consider include:

  1. The severity of your condition
  2. The subtype of your MS
  3. Other conditions you may have
  4. Other medicines you’re taking, and whether they’ll interact 
  5. Your age

“You really have to factor in your lifestyle, your values essentially, and your risk tolerance. There are some medications that have a higher risk, but that may have a greater benefit with regards to controlling MS,” says Dr. Harel. “That discussion of risks and benefits of certain medications is a really important discussion to have with your physician.”

What are questions to ask your doctor about your treatment options?

It’s important to remember that you play an important role in your care team. The more you understand your treatment plan, the better you’ll be able to carry it out. This may help improve your treatment outcomes.

Types of questions you can ask your doctor when choosing a treatment include:

  1. How will it affect my lifestyle, job, and schedule?
  2. What if I’m trying to conceive?
  3. What if I have a busy schedule?
  4. What if I travel a lot?
  5. What are the side effects?
  6. Are there long-term risks?
  7. How much will this cost?
  8. Will my insurance cover any of these options?
  9. How often will I have to administer this treatment?
  10. How often will I have to return to your office?
  11. What do your other patients think of this medication?
  12. How will this interact with my other medications?
  13. What do I need to know about my co-morbidities?
  14. How does this medication need to be stored?
  15. Why do you think this treatment is right for me?

What should you do if the first treatment you try is not a good fit?

Even after you’ve made a choice, be honest with your doctor if you don’t think your treatment is a good fit.

“If we see something that [your] MS is getting worse, for example, or if a medication doesn't really interact well with [you], we have the ability to switch options,” says Dr. Harel. “We have that luxury to be able to escalate.”

There are also plenty of complementary lifestyle changes you can make to support your treatment, like fish oil supplements, movement like yoga and reflexology, and even acupuncture.