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Making informed decisions about DMTs

David Schley

We’re funding research to help people with MS, health care professionals and regulators make choices about treatments.

Current disease modifying therapies (DMTs) work by preventing immune cells from attacking the brain and spinal cord. There’s a growing number of DMTs out there, mainly for people with relapsing MS.

Each has its own unique set of features – how it’s taken, different potential side effects, and how well it works. This can make for some difficult decisions.

Balancing the risks and benefits of different DMTs

In Leeds, Dr Ana Manzano is working to understand how people with MS choose what DMT to take, and what factors are most important in helping them decide.

Ana and her team want to see if health care professionals can better communicate the risks and side effects of DMTs.

Finally, they want to know how much people are willing to ‘trade off’ potential risks for improvements in their health. To do this, they are working with over 500 people through the UK MS Register.

> Join the MS Register

The importance of early treatment

Experts now agree that, for relapsing MS, DMTs should be offered as close as possible to diagnosis, rather than waiting to see whether more relapses occur.

Early treatment improves long-term health by slowing the build-up of irreversible damage in the brain and spinal cord, and reducing the number of relapses people experience. So it’s worth asking your MS nurse or neurologist if you should be taking a DMT.

> Find out more about the benefits of early treatment

What we don’t know is whether it’s better to start with one of the more aggressive DMTs. Some doctors believe we should be hitting the condition hard early on to minimise nerve damage and disability. Others suggest going more slowly to reduce the risks of severe side effects, only prescribing more aggressive DMTs if they’re needed.

We funded an initiative through our UK MS Clinical Trials Network to look at ways to answer this question.

And in September 2017, researchers announced the start of a multi-million dollar study led by the Cleveland Clinic in Ohio and the University of Nottingham. This study will help us understand if using an aggressive DMT early is the best option for people with MS.

The cost of not treating MS

We want people with MS to have access to the full range of DMTs that could work for them.

The cost effectiveness of DMTs is reviewed before they’re made available on the NHS. But these reviews aren’t specific to MS, and probably don’t consider the wider benefits of DMTs. This could lead to treatments unfairly being deemed too expensive for the NHS.

That’s why we’re funding Dr Annie Hawton at Exeter University. Her team wants to make sure that NHS regulators take into account the full social and financial impact of untreated MS symptoms before deciding which medicines can or can’t be prescribed.

Professor Ceri Phillips and his team in Swansea are also working to understand the real cost of not treating MS. They’ll work with people with MS to understand the impact that relapses and progression have on quality of life, the ability to work, and the support needed from family members and other carers.

Choosing a DMT is a personal decision

We know that deciding how and when you choose to treat your MS is a personal decision, and depends on many different factors.

> Take a look at Our Treatment Stories where people with relapsing MS talk about how they made a decision about their treatment.

This blog first appeared in Research Matters magazine. To receive Research Matters by post please contact [email protected] about subscription. You can also download the full issue for free.