How Well Is MS Treatment Working for You?

Most people who have multiple sclerosis (MS) are first diagnosed with relapsing-remitting MS (RRMS), marked by defined episodes of new or worsening neurological symptoms, followed by periods of recovery. Nearly everyone who has RRMS is treated with disease-modifying therapy (DMT). These medications help reduce the frequency of relapses, delay the progression of MS, and prevent future damage to the central nervous system. But they don’t improve existing damage or ease symptoms.

An estimated 20 to 40 percent of people with RRMS will eventually transition to secondary progressive multiple sclerosis (SPMS), where you have fewer or no distinct flare-ups, but symptoms gradually worsen over time. Since DMTs became available, fewer people with RRMS go on to develop SPMS, and those who do tend to transition later than ever.

Over two dozen DMTs are available for treating MS. “There is no one best disease-modifying therapy for everyone,” says Barbara Giesser, MD, a neurologist and MS specialist at Pacific Neuroscience Institute in Santa Monica, California. “Choosing a DMT is a very nuanced conversation between you and your neurologist. You have to consider a number of factors.” This includes how aggressive the MS is, what other health conditions you have, and your lifestyle and personal preferences. DMTs can be administered by mouth, injection, or intravenous (IV) infusion.

Chances are, you won’t stay on the same DMT forever. What works for you at one point could become less effective over time. Treatment may also need to change if you transition from RRMS to SPMS.

If you have the active or relapsing form of SPMS — where you may experience an occasional flare-up and have evidence of new brain lesions on an MRI scan — you may benefit from DMTs, as well as other interventions, such as steroids.

But if you have the inactive or nonrelapsing form of SPMS — meaning, a continuous, gradual worsening of symptoms, rather than flare-ups — you generally won’t benefit from DMTs. No medications are currently available to treat inactive SPMS specifically. Clinical trials are investigating a class of drugs known as Bruton’s tyrosine kinase inhibitors, though, to help improve inactive SPMS and slow disability progression.

The bottom line: MS is a progressive condition, so symptoms and treatment needs will likely change over time. Not to mention, new therapies are also emerging. That’s why it’s so important to regularly assess how well treatment is working.

Answer these questions to find out if your current treatment plan is as effective as it could be — and what to do if there’s room for improvement.

This assessment is part of a series aimed to help you check in on MS before your next checkup with your doctor. Take more assessments.