Multiple sclerosis (MS) is a chronic disease for which there are a plethora of disease modifying therapies (DMTs) available for treatment. According to the American Academy of Neurology, these therapies share the following features: all modify measures of disease activity such as relapse rates, the emergence of new or enhancing lesions on MRI, disability, or other parameters; none is curative; and all may have adverse effects , which may vary from bothersome to life threatening. The options have different mechanisms of action, risk factors, monitoring requirements, and delivery methods. Metanalyses have been conducted to help physicians in choosing treatments. For example, DMTs have been categorized according to efficacy with classification of low-efficacy (all interferon-beta preparations, glatiramer acetate, teriflunomide, fingolimod, dimethyl fumarate) or high-efficacy (ocrelizumab, mitoxantrone, alemtuzumab, daclizumab, natalizumab). Additionally, charts are available showing the types of drugs, their side effect profile, and routes of administration. Head-to-head clinical trials have also been conducted with published results to provide insight into what drugs might be superior per efficacy and side effect profiles, and how that might influence patient adherence and persistence.

What have you found to be the pros and cons of the various options? Please share your treatment choices based on patient considerations.

_References

• _{Weideman, A., Tapia-Maltos, M., Johnson, K., Greenwood, M., and Bielekova, B., 2017. Meta-analysis of the Age-Dependent Efficacy of Multiple Sclerosis Treatments. Frontiers in Neurology, 8: 577, p. 12.}
• _{American Academy of Neurology Policy and Guidelines: Multiple Sclerosis., 2018. Review Summary: Disease-Modifying Therapies for Adults with Multiple Sclerosis. Presentation Slides.}