Sometimes it seems as if people with MS are asked to flip a coin to make what’s arguably the most important decision they make about their treatment: which disease-modifying therapy (DMT) to use.
More than 20 DMTs are approved in the U.S. and many of those are available in the rest of the world. There are pills, injections, and infusions, and their efficacy, side effects, and costs vary significantly. One size does not fit all and it can be tough to figure out which is best for you.
Too many neurologists present MS patients with the names of just two or three DMTs and leave them to navigate the complex DMT waters on their own. This is very difficult for people who are new to MS and it’s not an easy decision for old-timers, either.
Wouldn’t it be nice if there was a way to logically choose the best DMT by taking into consideration a person’s level of disability, lifestyle, and risk tolerance? Well, a way is in the works.
Enter the DMT tool
A group of MS specialists at Barts Health in London is developing a “DMT tool,” which is an online application designed to remove much of the uncertainty when choosing a DMT. It does this by determining a patient’s unique health and lifestyle factors and matching their needs with the appropriate medications.
For example, do you care whether a treatment comes as a pill, injection, or infusion? Will a relatively minor side effect, such as flushing or hair loss, bother you? What about long-term side effects? Are you able to regularly visit a doctor’s office or other location to be treated? Are you more interested in preventing relapses than in slowing long-term disability? Do you plan to become pregnant?
“The goal of this DMT tool is empowering pwMS to pick a treatment ‘rationally’ after being offered two or three drugs by their MS team,” Barts Health neurologist Ide Smits wrote on the MS-Blog. “In our opinion, a rational treatment choice translates into a drug with a high efficacy when it comes to treating your MS but is equally compatible with your lifestyle, personal and professional ambitions.”
Test-driving the DMT tool
I’ve had a look at the DMT tool, which is currently being tested, and I’m impressed.
To use it, first select the DMTs your neurologist has suggested. (Right now, the tool lists nine available in the U.K.)
Then, use a pull-down menu to answer eight questions about your healthcare and lifestyle needs. The tool suggests which health or lifestyle factors might be associated with each question, such as active or quiet MS, frequent travel, or busy schedule, for example. Answers range from unimportant to very important.
When that’s finished, click a button and you’re presented with two graphs. A bar graph shows the level of suitability for you of each DMT you’re considering, while a line graph shows how each DMT ranks for each of the eight considerations you provided.
The proof is in the DMT selection
I entered the four DMTs I’ve been treated with — Avonex, Tysabri, Aubagio, and Lemtrada — and answered the eight questions. As shown in the graphs above, the tool ranked the DMTs from most to least suitable for me: Lemtrada, Tysabri, Aubagio, and Avonex. That’s exactly how I would have ranked them based on my actual experience with each.
Wow!
The members of the team that designed this MS tool are anxious to have people try it out and provide feedback on its design, content, and overall usefulness. A link to do that can be found at the bottom of the testing site.
I encourage everyone to take a look and let the folks at Barts know what you think. Let us know, too, in our comments.
(A version of this post first appeared as my column on the MS News Today website.)
(Featured image by Sophie Janotta from Pixabay.)
