“There are a lot of different factors to consider when choosing a multiple sclerosis (MS) medication,” says Asaff Harel, MD, neurologist and Director of the Multiple Sclerosis Center at Lenox Hill Hospital, Northwell Health. “With over 20 different options… 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.
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:
Injections that you give yourself
Infusions that you receive from an IV at an infusion center
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.
The severity of your condition
The subtype of your MS
Other conditions you may have
Other medicines you’re taking, and whether they’ll interact
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.”
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.
How will it affect my lifestyle, job, and schedule?
What if I’m trying to conceive?
What if I have a busy schedule?
What if I travel a lot?
What are the side effects?
Are there long-term risks?
How much will this cost?
Will my insurance cover any of these options?
How often will I have to administer this treatment?
How often will I have to return to your office?
What do your other patients think of this medication?
How will this interact with my other medications?
What do I need to know about my co-morbidities?
How does this medication need to be stored?
Why do you think this treatment is right for me?
Even after you’ve made a choice, be honest with your doctor if you don’t think your treatment is a good fit. Because there are so many medication options today, you and your doctor can generally try other options to find the right fit.
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.
Gajofatto, A. et al. (2015) Treatment strategies for multiple sclerosis: When to start, when to change, when to stop? World Journal of Clinical Cases.
MedlinePlus.gov. (2021). Multiple sclerosis.
Multiple Sclerosis Association of America. (n.d.). Welcome to the MSAA ultimate MS treatment guide.
National Center for Complementary and Integrative Health. (2019). Ayurvedic medicine: in depth.
National Center for Complementary and Integrative Health. (2019). Multiple sclerosis.
National Institute of Neurological Disorders and Stroke. (2023). Multiple sclerosis: What research is being done?
National Multiple Sclerosis Society. (n.d.). Treating MS.
University of Michigan Health. (2023). Multiple sclerosis: Should I start taking medicines for MS?