How can I know if my multiple sclerosis (MS) medication is working?

The goal of current treatments in multiple sclerosis (MS) is to prevent further disability; they do not cure or reverse existing deficits. To evaluate whether your medication is effective, the doctor will monitor your clinical relapses, changes in your magnetic resonance imaging (MRI), and changes in disability levels. Most experts say that you need at least six months to decide if the treatment is not working—a couple of months for the medication to reach desirable levels, and a few more to see if it stops the attacks.

Monitoring your clinical relapses involves knowing how many relapses you have within one year; determining if the number decreases within six months of treatment; evaluating how severe they are and how much time it takes you to recover; and noting if they respond to steroid treatment.

When using MRI to monitor your MS, you should know that MRI can show the disease activity only when you can compare with previous MRIs. Experts say that two or more new T2 lesions on each repeated scan separated by at least quarterly intervals can be indicators of treatment failure.

It is also important to evaluate disability progression. The Expanded Disability Status Scale (EDSS) is the measure used to determine neurologic disability. An EDSS done after an attack only measures the severity of the attack and not the acquired disability. When you start with a score of 3.0 to 5.5, an annual increase of one point in the EDSS is considered worrisome. The same happens if you start with a score of 6.0 or greater and in the absence of an attack have a 0.5 increase. This may indicate that the previously relapsing-remitting patient has transitioned to secondary-progressive disease or that the person with secondary progressive MS has only a partial response to therapy.

Another way to know if the medication is not working is testing for neutralizing antibodies. As the name implies, these antibodies neutralize the medication, preventing it from working properly. Studies have demonstrated that up to 41 percent of patients develop persistent neutralizing antibodies on high dose interferon therapy within the first 12 to 24 months. Other studies have questioned how important these antibodies are, and there is no clear consensus on testing for them.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.