Which Is Best for You?

When you have multiple sclerosis, you know how important medicines are. They reduce your relapses and keep your disease from getting worse as quickly. But when it comes to MS medications, there’s no one-size-fits-all. The best medication for you depends on many factors, including your lifestyle and medical history.

So how do you choose? We asked Robert Shin, MD, director of UVA Health’s MS and Clinical Neuroimmunology Division, what you should consider when deciding between MS medications.

The 3 Main Types of MS Medications

When it comes to MS medications, you’re looking at 3 categories of something called disease modifying therapies (DMT). That’s a fancy word for medicines that target the underlying cause of MS. DMTs don’t cure MS, but they can slow it down and prevent relapses.

First Generation Injectable Therapies

These were the first DMTs approved by the FDA, in the 1990s. They include beta interferons and glatiramer. They’re available under many brand names, such as Avonex and Glatopa. Glatiramer is also available in generic form. You inject these yourself, at home. Depending on the medication, you may do this daily, several times a week, weekly, or 2 weeks apart.

Oral Medications

MS medications in pill form came on the market in the 2010s. These are daily medicines with no needles involved.

There are different types of oral DMTs, including:

• S1P agents, with brand names like Gilenya and Mayzent
• Fumarates, such as Bafiertam and Tecfidera
• Teriflunomide (brand name Aubagio)
• Cladribine (brand name Mavenclad)

You take most of these once or twice a day.

Monoclonal Antibodies

The third kind of DMTs, monoclonal antibodies, came on the scene starting in 2017. These may be the most effective medications available to treat MS, Shin says. They’re given as either intravenous (IV) infusions or injections.

These include:

• Natalizumab (brand names Tysabri or Tyruko)
• Alemtuzumab (Lemtrada)
• Ocrelizumab (Ocrevus or Ocrevus Zunovo)
• Ofatumumab (Kesimpta)
• Ublituximab (Briumvi)

You take these monthly or once every 6 months. Infusions are given at clinics, infusion centers, and hospitals.

Things to Consider About Your MS Medication

Shin shared these key questions to ask yourself when you’re choosing between MS medications.

How Well Does Your Current Medicine Work?

If you’re using an older medication and struggling with relapses, it could be time to switch. The newer meds, especially monoclonal antibodies, tend to work better overall.

That doesn’t mean that you automatically must switch if you’re on an older med. If your MS is well-controlled, you may want to stick with what you’re taking. But if you’re not getting enough MS control from an older medicine, one of the newer ones could work better for you.

Are You Having Side Effects?

Side effects from MS medications vary from person to person. Some people have more mild side effects. Some have severe reactions. If side effects of one kind of med are too hard or dangerous to tolerate, you may want to try something different.

Which Option Is Most Convenient for Your Schedule?

In part, this comes down to personal preference. If you live far from an infusion center or you’re scared of needles, you might prefer a pill. Or if remembering to take a medicine every day, setting aside one day every month or every six months for an infusion or injection might seem easier.

Are You Pregnant or Thinking of Having a Baby?

Amazingly, pregnancy is temporarily protective against MS. That means your MS may not be as bad while you’re pregnant.

But you’ll want to talk to your doctor about stopping MS medications before becoming pregnant and starting again after you have your baby.