For some people, a diagnosis of MS is a relief, giving a name and a reason for a range of strange and unsettling symptoms. For others, a diagnosis of MS brings images of the worst possible future. Both reactions will likely change somewhat over time, but for many with MS, diagnosis is a day when life changes. Even before the news can be fully absorbed, people with MS face a decision about taking a disease-modifying therapy.
MS neurologists agree people with MS benefit from early treatment with disease modifying therapies that can reduce the frequency and severity of attacks and slow the progression of disability.
Reduce the frequency and severity of clinical attacks (also called relapses or exacerbations), which are defined as the worsening of an MS symptom or symptoms, and/or the appearance of new symptoms, which lasts at least 24 hours and is separated from a previous exacerbation by at least one month.
Reduce the accumulation of lesions (damaged or active disease areas) within the brain and spinal cord as seen on MRI (magnetic resonance imaging).
Appear to slow down the accumulation of disability.
These treatments, which are generally taken on a long-term basis,
are the best defense currently available to slow the natural
course of MS. Even though the disease-modifying therapies don’t
generally make a person feel better, they can be looked upon
as an investment in the future.
» Managing Side Effects
of Disease-Modifying Therapies
Not everyone will experience every one of these side effects. Some adverse effects are common, and others are very infrequent but may be serious. Your health care provider can give you a better sense of how frequently problems occur with the specific agent he or she recommends for you. The industry-sponsored websites may also give you an idea of how frequently these effects occur.
The flu-like side effects of the interferon products — Avonex, Betaseron, Extavia, and Rebif — can usually be managed successfully. Discuss this with your physician or other health care provider, and the patient support program of the pharmaceutical company (available through a toll-free number — see chart entitled “Industry-Sponsored Sites” below). Should unacceptable side effects continue, discuss the possibility of changing to another treatment with your doctor.
The therapies that are injected subcutaneously including Betaseron, Copaxone, Extavia, and Rebif, may cause injection site reactions, including bumps, bruises, pain, and infections. Good injection techniques can minimize problems. Autoinjecting devices may be helpful. The pharmaceutical company patient support programs offer injection training and helpful tips for avoiding or limiting site reactions (see chart entitled “Industry-Sponsored Sites” below).
» Benefits of the Disease-Modifying Therapies
Reducing the frequency of attacks and new lesions as seen on MRI
All of these medications have been shown to reduce the frequency
of MS relapses and the development of new lesions. In individual
clinical trials comparing a drug versus an inactive placebo
treatment, MS attacks were reduced by 28–68 percent by different
agents. In the clinical trials, most people were also found
to have fewer, smaller, or no new lesions developing within
their central nervous system as visible in MRI scans.
Preventing permanent damage
Permanent damage to nerve fibres (called axons) occurs early in MS in association with the destruction of myelin. Overall brain shrinkage (or atrophy), can occur early in the disease, and damage can be ongoing even when the person has no symptoms of an attack and feels well. Therefore, MS specialists advise the early use of a medication that effectively limits lesion formation and brain atrophy, or shrinkage.
None of these medications are recommended for women who are
pregnant or plan to become pregnant. Physicians should be consulted.
Most women will be advised to avoid using these treatments
» The Bottom Line
Many factors will influence the decision that you and your physician make about your choice of medication. One of them will be lifestyle issues that could affect your ability to stay with a treatment over time. Another factor is your response to the therapy, which should be carefully tracked. If your MS is not responding, you and your physician should discuss your options.
» Provincial Drug Programs – Contact Information
Alberta Blue Cross: 1-800-661-6995
Pharmacare Special Authority Process: 1-800-554-0250
Pharmacare Exceptional Drug Status: (204) 788-6388
MS Prescription Drug Program: 1-800-332-3692 or (506) 867-4515
Newfoundland and Labrador
Prescription Drug Program: (709) 729-6507
Special MS Therapy Program MS Clinic: (902) 473-1881 or (902) 473-5734
Ontario Drug Benefits Section 8 Mechanism: 1-866-811-9893 or (416) 327-8109
Prince Edward Island
MS Program: 1-877-577-3737 or (902) 368-4947
Régie de l’assurance-maladie du Québec (RAMQ) — service de l’expertise pharmaceutique: 1-800-561-9749 or (514) 864-3411