Disease modifying drug therapy Switching and discontinuing
There are two main reasons why people might switch from one disease modifying drug to another, or discontinue treatment altogether. These are:
- lack of effectiveness
- unmanageable side effects
Switching
It is important to have realistic expectations about the drugs and what they might achieve for you. The benefits of these drugs may not be immediately evident and may only be seen after time.
However, if after a period of time, your relapses continue at the same rate and with the same severity as before drug treatment, you may be able to switch to another disease modifying drug. Your consultant and MS nurse will advise you of your eligibility and suitability for other disease modifying drugs.
If you are receiving one of the interferon beta drugs, regular blood tests may be carried out to check for neutralising antibodies. The presence of neutralising antibodies alone may not necessarily indicate reduced effectiveness and further signs that the treatment is not working would have to be present in order to warrant switching or discontinuing treatment.
A small number of people find that the side effects of a particular disease modifying drug are unmanageable. If after some time, your side effects have not subsided, and the management techniques advised by your MS nurse have proven ineffective, you may be able to switch to another drug. Again, your consultant and MS nurse will discuss the available alternatives with you.
Discontinuing
While disease modifying drugs are a long-term commitment, for most people this will not mean they are a life-long commitment. Even if the drugs are effective for a period of time, there may come a time in the course of your MS when these drugs are no longer effective.
There are no mandatory stopping criteria that apply in all cases, but the ABN has set guidance on when treatment with self-administered disease modifying drugs should be stopped because they are no longer effective. Generally, the ABN guidelines recommend stopping treatment if:
- the individual experiences two disabling relapses, as defined by the examining neurologist, within a 12 month period
- the individual develops secondary progressive MS and no longer experiences relapses
- the individual loses the ability to walk, with or without assistance for at least 6 months
Your neurologist and MS nurse will discuss the stopping criteria and advise you when it is an appropriate time to discontinue treatment. In some cases, treatment will be gradually withdrawn.
Stopping treatment can often have a greater impact psychologically than physically. It is difficult for some people to accept having something that has helped them completely withdrawn. However, your health professionals will support you throughout the process and help you regain focus in the management of your condition.