Disease modifying treatments
Approaches to managing MS includes lifestyle interventions such as diet and exercise, wellbeing support such as mindfulness and cognitive behavioural interventions, physiotherapy and medication.1
Medication usually takes two difference approaches: medicines for treating symptoms and disease modifying treatments (DMTs), also known as disease modifying drugs (DMDs). DMTs can broadly be divided into immunosuppressants and immunostimulants, but their modes of action in MS are not understood fully.
DMTs will not cure MS, nor can they repair nerve damage already caused by MS so are not able to reverse existing symptoms. And unlike symptomatic treatment, it can take a few months before some DMTs’ full effects are apparent.7
However, DMTs can reduce the number of relapses, slow the progression of disability and maintain or improve quality of life. They may also increase longevity; average lifespans for people with MS are 6-7 years shorter than for the general population, and the gap is closing all the time.8,9
DMTs will be initiated by specialists and usually managed through the hospital. They are available as injections and oral products with some preparations having unusual dosing strategies (see panel).10,11
Provision may vary across the NHS with NICE technical appraisals and Scottish Medicines Consortium recommendations differing slightly, for example under what conditions or restrictions the DMT is recommended. Eligibility can depend on disease type, activity levels (based on MRI scans), or if the disease has responded inadequately to other DMTs.12,13