Which Disease-Modifying Therapy (DMT) is Best For Me?
This past January I had a *cute little surprise* from my bestie, MS, in the form of a new lesion in a precarious spot. While it is extremely validating to have a visible explanation to why I was experiencing new and worsening symptoms, it also meant I needed to switch medicines.
Again.
I've tried so many DMTs
I grew up in the golden era of research for MS. When I was diagnosed in 2005, fewer disease-modifying therapies (DMTs) were available; now there around 20!1
In the 18+ years I’ve had MS, I switched DMTs when I had a relapse in hopes of finding something that would better reduce breakthrough disease activity. Thus, I’ve tried 8 medicines: Rebif, Avonex, Copaxone, Betaseron, Gilenya, Tecfidera, Ocrevus, and Mayzent. My most recent DMT, Mayzent, is what I was on when I developed a new lesion and symptoms. The verdict was in: Mayzent works for a lot of people, but for me, Mayzent was not it.
After having a good cry (or a few), I put my researcher hat on.
Having to select a new one
I have a background in pharmaceutical sciences, and I knew that my options for a new medicine were whittling down, especially since my diagnosis shifted last year from RRMS to active SPMS. My doctor presented me with two options based on her vast knowledge and my past experience. I knew this decision would be a hard one, so I asked for time to do my own research.
During the weeks (yes, weeks, I am a thorough researcher) that followed, I scoured so many clinical papers, research studies and anecdotal evidence. In between grieving yet another change, I did my own soul searching by asking myself questions like:
- What are my goals?
- What amount of risk am I okay taking?
- What side effects would I accept?
- What is my preferred way of administering treatment?
- Which of the DMT options fit into my life better?
In an effort to keep all the information straight I compiled a highlight sheet for each medicine, including how it was dosed, side effects, clinical trial results, and my own personal pro/con list. After taking all this into consideration, I put together a list of questions for my doctor.
Waffling back and forth
My doctor suggested a virtual meeting with the clinical pharmacist on their team to address my questions. In my experience, learning about trial results, side effects, etc., all need to be put into perspective. I think a clinical pharmacist is the perfect person to help with that.
Side effects may sound terrifying, and knowing the percentage of people that experience a specific side effect can help put a racing mind at ease (a little), at least for me. That meeting with the clinical pharmacist helped a lot, but I still wasn’t sold. In an effort not to waffle back and forth endlessly, I gave myself a deadline: I would decide after the weekend.
Making a decision
Monday morning I emailed my doctor with my decision. Both medicines they suggested made sense for different reasons. I opted to go with the less risky option based on my goals and priorities. Someone else may have made a different decision, and that is okay. I knew deep in my soul that I needed to go the less risky (in my mind) route before taking on higher risk.
At the end of the day, I think it’s an absolute gift to be living in a time where there are so many effective choices, each with different trade-offs. In my opinion, when deciding on DMTs, I think it's important to listen to a doctor’s guidance, ask questions, take into consideration what you are comfortable with, and understand that nothing in life is perfect.
There is not one medicine that is better than another, and no one can tell you what the best decision for you is with 100% certainty. It would be great to have a crystal ball, but all you can do is do your research and then choose the DMT you feel the most comfortable with based on your own goals.
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