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To Switch Or Not To Switch Medications. That Is The Question.

“Every day brings new choices.” ~ Martha Beck

Reader FavoriteBy now, patients with Multiple Sclerosis are aware that the Food and Drug Administration approved Biogen’s Tecfidera, the third oral medication available for people with MS.  According to a March 27 New York Times article, “Despite the drug’s seemingly odd history, Wall Street analysts, doctors and patients expect Tecfidera to become a blockbuster because of its combination of efficacy and relative safety and the convenience of being a pill. Doctors and analysts say some patients have been putting off starting treatment until Tecfidera is available.”1

Tecfidera has been highly anticipated by the MS community, with its higher efficacy rate (44 and 53% in two separate trials) than another oral drug, Aubagio (30%), and few testing requirements, unlike that of the oral medication, Gilenya.

According to the NY Times article, “The injectable drugs reduced the frequency about 30 percent.”

As a health advocate, I often tell newly diagnosed patients they are ironically diagnosed during an exciting time, when pharmaceutical companies are spending millions and millions of dollars researching new and better ways to treat patients with MS.  In the Dark Ages when I was diagnosed, the only phrase you’d hear from your physician was, “Go home and rest.  Call us if you experience an exacerbation.”  There were no medications to treat MS.

“A strong mind always hopes, and has always cause to hope.” ~Thomas Carlyle

Times have changed.

With the impending news of Tecfidera becoming an approved drug, I’ve been asked on many occasions, “Should I stay on the medication I am currently on, or switch to a new one?

The answer is: Only you and your doctor know the answer to what medication is right for you.  But before making any decisions, ask yourself the following questions, giving yourself time to answer them thoughtfully and honestly:

  • How are you doing/feeling on your current medication?
  • Are you taking your current medication as prescribed?
  • If not, what is preventing you from taking it correctly?
  • What side effects are you currently experiencing?
  • No medication is a cure.  Is your current medication reducing the amount of flareups (and the duration/severity) you are experiencing?
  • What do you like about the medication you are considering?
  • Have you researched the medication under consideration for side effects, required testing and cost?

“Knowing others is wisdom, knowing yourself is Enlightenment.” ~ Lao Tzu

Make a list of concerns about the new medication and your current medication. Go over them, and speak to your doctor about them.

After consulting with your physician, performing complete research on the medication and answering your own questions, the rest is up to you.

Know your options.  Reach out for help.  Talk to your doctor.  Check MultipleSclerosis.net forums to share your concerns with others.  Post your questions.

We at MultipleSclerosis.net are here to help, because the MS community is the backbone of empowering one another in our fight against Multiple Sclerosis.

“Healing is a matter of time, but it is sometimes also a matter of opportunity.” ~ Hippocrates

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1.Pollack, Andrew. "3rd Oral Drug to Treat MS Is Approved by the F.D.A." The New York Times. Available at: http://www.nytimes.com/2013/03/28/business/3rd-oral-drug-to-treat-ms-is-approved-by-the-fda.html?

Comments

  • zenhead
    6 years ago

    I’d be happy to consider new/different medications, if “they” would ever come up with something new for progressive forms of MS. I get all excited when something new is announced, only to find it is intended for RRMS. Aren’t there enough meds for RR? Im waiting for a breakthru for SPMS. Maybe stem-cell therapies?

  • Bill B.
    5 years ago

    Zenhead, you’re sure not alone in your wish for more (any) treatments for SPMS or PPMS. Trust me on that. Sometimes I have to recall that, prior to 1993, there was NOTHING at all! And, of course, 1993 wasn’t that long ago, in the grand scheme of things, right? Be as patient as possible, knowing that we live in as exciting a time as ever in MS research. Hopefully, we’ll soon be seeing treatments for progressive forms. Be well!

  • Crystal
    7 years ago

    Hi. I was dx in July of 2009 and have been on Copaxone ever since. I’m strongly considering switching to Tecfidera, but am concerned about the fact that it is a newbie on the market. Have there been any other reports of side effects since it’s release?
    The Copaxone seems to be doing it’s job, but the anxiety and pain that I experience leading up to and after each injection is what I think causes the stress that affects me adversely every day. The thought of just taking a pill makes me sorta giddy! 🙂
    Hoping you can let me know if there have been any new reports.
    Thanks in advance.

  • Bill B.
    5 years ago

    Crystal, I was on Copaxone for ten years. Over the years, I’ve been on just about all of them. I do give Copaxone credit for getting me past a life long deathly fear of needles. If it did me any other good, who knows? I’ve been on Tecfidera since November of last year and I’m quite pleased with it so far. Of course, everyone’s body is different and you should consult with your neurologist or whomever is following your treatment, etc. Good luck.

  • skinser
    7 years ago

    My husband has MS. diagnosed 2/2011 so far just 2 lesions..permanent numbness in his right leg from mid thigh down.. and the “MS Hug”. I printed out the med info on the new pill Tecfidera, for him to read. He also will be seeing his neurologist. He has had some flare ups. But his biggest issue is the injections. He takes Rebif…They are painful, reaction sites are very sore and tender.. causing him to have a disturbed sleep, the meds over all cause fatigue and flu symptoms(worse if he doesn’t get good nite sleep). Rebif has caused him to have early onset of diabetes(takes metformen)He is a concrete finisher/supervisor. Has to work out of town frequently. He is very uncomfortable asking coworkers to give him his shot when he can’t physically reach them himself. So then he’s stressed. Fatigue and flue like symptoms on a hot day pouring concrete is extremely hard for him. He is definitely interested in talking to the neurologist about the new meds. His overall health before MS diagnosis was great.. was taking care of high blood pressure and cholestrol(family history). We took out all sugar drinks. limit sugary foods(diabetes)simple carbs & eat alot more vegies. We only eat venison or elk for red meat(has no cholestrol)we are avid bowhunters. I like this forum… great folks sharing their stories.. Thanks 🙂

  • Cathy Chester moderator author
    7 years ago

    I think it would be a good idea, as you said, to investigate an oral medication for him since he’s away a lot. Perhaps you’ve already visited the doctor to discuss this. Let us know what course your husband began.

    You are a good wife to write to us about him, and we are so glad to have you here at MultipleSclerosis.net. Please keep us posted on his journey; we are here for you always.

    Cathy

  • Deb Padovano
    7 years ago

    My daughter has MS, not myself. I signed up for this newsletter to educate myself. I was really happy to see this article on medication. My daughter will soon, within the next couple of weeks, more than likely have to make a decision as to whether or not she will switch medicatons. She hates the thought of taking any medications or injections. Her neurologist has been suggesting a change but my dughter is leary. I forwarded this article to her. I think it has many positive suggestons and questions to ask herself and her doctor. Thank you….xxxooo

  • Cathy Chester moderator author
    7 years ago

    Deb,

    I am so glad my post helped you and your daughter!

    Please let her also know she is never alone. The MS community is a strong one, and we will wrap ourselves around both of you. If either of you have any more questions, please ask away.

    Keep us posted on how she is doing. The good thing about today’s MS is there are many choices of medications. If one doesn’t work, keep trying until you find what’s right for you. Hopefully the first one will be a charm for her!

    Best~
    Cathy

  • Steve
    7 years ago

    Just changed neurologist for the first time since being diagnosed in 2005. It opened up new possibilities/new options. My previous doc was of the same ilk, “Well, you know MS is a degenerative disease so getting gradually weaker is to be expected…” I got tired of hearing that.
    The new doc is saying I may not even have RRMS or SPMS but some un-named in between version. This article was a good affirmation that I’m taking the right approach. Options for me are to discontinue Avonex and see what happens, if I relapse, then flip to the new oral drug, or just flip to the oral from Avonex. I’m leaning toward option 1 but only because the flair ups I’ve had (only 2 or 3) in 8 years have not really been true relapses according to my new doc.
    If I can gain back some energy from the lack of Avonex induced side-effects that drag me down Sat. – Mon. every week that could lead to increased energy to hit the gym and just in general be more active. Don’t be afraid to explore your options. I’m happy (so far) that I did. Options=Hope.

  • Cathy Chester moderator author
    7 years ago

    How true, Steve. Options do equal hope!

    My only question is: are you comfortable in not being on a disease-modifying medication at all? Perhaps not Avonex (as you stated) but one of the other approved options? MS is always going on inside of us. Even though we may feel better, being on a medication is “extra insurance” that we may stay better.

    I was diagnosed before any options at all (26 years ago). Having a full array of medications to help me in my quest of feeling well is a choice I love having.

    Consider speaking with your doctor about getting on another med. A friend’s simple opinion!

    Best to you, and thanks for leaving your comment,
    Cathy

  • Steve
    7 years ago

    Cathy – I agree with you although I’m somewhat on-the-fence on this issue. I need to talk it through with my neurologist. Amazingly it was the neurologists’ suggestion to just discontinue the Avonex as my history did not show a RRMS pattern. One of my questions will be regarding my MRI history over these 8 years. If lesions have increased significantly in both brain and spinal cord along with gradual increase of leg-weakness and constant fatigue (plus the transitory exotic stuff), then I would think taking something is better than taking nothing. I can’t help wondering about the logic of “you are not in an RR pattern….Beta Interferon is used to reduce the number of relapses, why take it if they are not an issue?”. And “if you go off of the interferon and have a relapse we can always then treat with the new oral med”. I mean that in a
    way leaning toward the scientific curiosity of “what-if”?
    At a minimum I’d want to monitor my MRI results closely if deciding to stop treatment.
    My concern here is also regarding insurance. Will dropping Avonex for a period and then trying to get the oral drug prescribed/covered give any leverage to the insurance company in denying coverage(?). Who knows, but these are considerations. I’ll let you know how it all falls out. It’s great to know that drug options are appearing with reduced side-effects though. (Also, I would never advocate that anyone discontinue their Avonex or other therapy. For all I know that is why I’m still going strong after 8 yrs.)

    – Steve

  • Cathy Chester moderator author
    7 years ago

    Steve,

    I respect your decisions because they are just that – your own! You see to be smart about knowing what to look for and what does (and does not) work for your body. Keep going on that path. Make sure you believe your doctor is in sync with what you believe. If not, perhaps look around for another. But keep going with your ability to find answers for yourself and following your intuition. You’re doing a great job.

    Keep us posted,
    Cathy

  • Sonya
    7 years ago

    Steve,
    Thanks so much for replying. I value your input & ideas about your treatment. Please keep me posted on what you decide & how you do with whatever treatment you decide to follow.
    I agree about the diet. My husband & I no longer eat red meat, & most dinners are vegetables. I do try to drink the water, especially on the day I inject. I can no longer take the Aleve, as I am on Meloxicam for arthritis of the hips & spine. My son & daughter-in-law are , he /vegetarian, she/ vegan, so I am looking at their diets more closely.
    I too worry about taking too many drugs, especially the supplements. How often do you have the MRI’s. I’m having them done about every 18 months. The last, done in Oct. 2012, showed no signs of new lesions. I look forward to hearing from you, from time to time. I pray everything goes well.
    Sonya

  • Sonya
    7 years ago

    Hello Steve!
    My name is Sonya & I appreciate your views on the article “To Switch or Not To Switch Medications.” I too have had the same neurologist from the beginning of my diagnosis….I am in year 6, & have been on Avonex the whole time. I too have been thinking about a change, so it is nice to know others follow this same train of thought. May I ask, do you use any alternative plans of action…..such as diet or supplements? I would certainly be interested in hearing from you, & knowing how your journey proceeds. My biggest side-effect is the fatigue, & sometimes chills on the day I inject, followed by a headache the next morning 🙁 I wish you the best in this new endeavor!

  • Steve
    7 years ago

    Sonya,

    I’ve been on Avonex since 2005 and have been very faithful in taking it every week although it makes me sluggish, dizzy and content to do-nothing on most weekends. The injection factor I’ve never had a problem with but the added malaise, fatigue and “spaciness” I have hated with a passion. My job usually entails working until 6 or 7 and getting home around 7 or 8PM. By then I have little motivation to exercise which I know is important. So the new oral drug option is very enticing to me. If I can gain more energy by not dealing with Avonex side-effects during the portion of the week I do have free to work out or just be more active that would be amazing. I’m learning that diet can play a significant role in the fatigue symptoms. When I eat heavier meals or foods that take longer to digest (steak) I tend to notice increased fatigue. I’m starting to migrate to healthier foods, smaller portions. Not eating out at lunch is helpful too. I can be content with healthy fast food for lunch (yogurt, granola bar and a pc of fruit)vs. what I’d have by going to a chain restaurant with co-workers. For your Avonex headache try to ensure that you are well-hydrated both beforehand and afterwards. That does help a little bit (I take an Aleve about an hr. beforehand too). I have not tried any herbal-type supplements. I lean toward believing that less-is-more when it comes to drugs or supplements other than basic multi-vitamins, baby aspirin. I have taken Gabapentin for years as I’ve had spasms and electrical spark sensations that this drug dampers. Amantadine has helped my fatigue a little bit. The anti-depressants that I’ve tried have been hard for me to tolerate except in very small doses. The best anti-depressant is exercise and activity. Good to chat with you. – Steve

  • Sonya
    7 years ago

    I see my doctor in July & I plan to discuss this new medication with her. I’m fairly certain she won’t suggest changing from the Avonex I now take. She is usually of the opinion, “if it ain’t broke, don’t fix it.” 🙂
    I appreciate the article & the considerations. Sometimes we are so anxious to try something new, we fail to look at things from all sides. Even though I H-A-T-E the injections, cost will definitely be a huge concern for me.
    Thanks again for an interesting article.
    Sonya

  • Cathy Chester moderator author
    7 years ago

    Thank you, Sonya. You should also take some time to think about what you want and discuss your concerns with your doctor. Together you can make the right decision for you, based on research (and of course what you insurance company says…) Please keep us posted on how you are doing.

    Thank you for your comment.
    Best,
    Cathy

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