When should you start using a DMT?

A friend of mine was diagnosed with Multiple Sclerosis about fifteen years ago.  She’s been very stable since her DX without being on any disease modifying drugs.

But, we’ve both wondered if she should be proactive and start using using Avonex, Betaseron, Copaxone, Tysabri or another of the many disease modifying therapies that are available today.  So far, her neurologist has suggested that my friend hold off.

I’ve lived with MS since 1980 and I was in the original Phase-III study of Avonex back in 1996.  After several years on Avonex I moved to Tysabri and then to Aubagio.  So, I’ve been doing these drugs a long time. Over those years I’ve asked myself a lot, “was starting down the DMT road the right thing to do when I did it?”  I really can’t say. My MRIs show the plaque in my brain has been stable, yet my disability has certainly increased over the past twenty years, or so.  Would my Multiple Sclerosis have worsened more had I not been using those drugs?  Who knows?

Translate that uncertainty to my friend’s situation. When is the right time for her to begin a DMT?  Today?  After a serious exacerbation?  Should she have started years ago or does she have years to go before she takes that plunge?  There’s an interesting article about this in the June 23rd issue of Neurology Today.  It reports on a debate on this question that occurred at the annual meeting of the American Academy of Neurology last April.  As the introduction to the article says, “the answers were almost as vexing as an individual’s disease course.”  It’s a very interesting read.