Disease Modifying Drugs
Disease modifying drugs (DMDs) are a group of treatments for people with Multiple Sclerosis. Many DMDs are approved for people with Relapsing Remitting MS (RRMS), but some are also approved for a group of people with progressive MS.
In the UK, a wide range of disease modifying drugs are approved for use by the NHS. There are different benefits and risks associated with each drug.
Benefits of DMDs
DMDs offer the following benefits:
- Fewer relapses
- Less severe relapses
- Reduce the build-up of disability which can occur if you don't recover completely from relapses
To reduce inflammation caused by MS in the brain and spinal cord, DMDs work with different parts of the immune system. As a result, fewer relapses occur and the severity of them is reduced.
DMDs work with different parts of the immune system to reduce the inflammation caused by MS to nerve cells in the brain and spinal cord. This helps reduce the number and severity of relapses.
Symptoms of inflammation are not always visible or result in clinical relapse. The invisible activity may mean that even if you feel well, there are still changes caused by your MS that are only visible on a brain scan. As shown in MRI scans, taking a DMD can result in fewer, smaller, or no new areas of brain and spinal cord damage (lesions). It is becoming more important to treat both the visible (clinical relapses) and invisible (changes seen only on brain scans) aspects of MS; the goal being no visible or invisible MS disease activity.
The average person with Relapsing Remitting MS has one or two relapses per year. DMDs are prescribed in the NHS based on your frequency of relapses. NHS England describes Relapsing Remitting MS as being either active or very active.
Effectiveness of DMDs
There is no clear answer to whether one DMD is better than another. There are different ways in which they work, and what works for you may not work for someone else.
It may take three to six months for some DMDs to be fully effective.
Some people will still experience symptoms of MS because DMDs do not have an effect on MS damage that has already happened.
Prescribing DMDs
You will be told if you are eligible for DMDs, and if so, which are suitable for you. Recommendations will be made based on your MS activity level, how relapses have affected you, and the number of relapses you have had.
MS DMDs are funded by NHS England and not the hospital or Trust. When prescribing a DMD, your MS team must work within strict NHS England criteria. DMDs can only be prescribed by certain neurologists, consultant nurses, pharmacists, or allied health professionals.
If you are given an option of treatment, you should consider the pros and cons of each option. You may consider things like ease of taking a drug to be an advantage. Disadvantages may include side effects or the inconvenience of attending a hospital setting for treatment. Every person will have a different perspective on what they consider an advantage and disadvantage. The MS Decisions aid | MS Trust may be useful in comparing different treatments.
Starting treatment
You will not be required to pay for the DMD if you are eligible for NHS treatment, although you may be required to pay prescription charges for some of the drugs.
Depending on which drug you are prescribed, you may have it delivered and dispensed to you at your home, or chosen address, by a designated pharmacy homecare delivery company, receive it in the hospital as a day patient, or collect it from the Poole Hospital pharmacy (Boots). If your drug is one being delivered and dispensed by a pharmacy homecare delivery company, it is important that you consider how your drug needs to be stored; if it needs to be stored in a fridge, you will need to get it into a fridge as soon as it is delivered.
Before starting a DMD, the MS team will educate you on how the drug works, how to take it, how to manage side effects, what monitoring is required, and who to contact if there are any issues.
If you are starting an injectable treatment, you may need to attend Poole Hospital for your first injection so your MS nurse can show you how to do the injection and monitor for any possible reactions.
The treatment of DMD requires a long-term commitment. The MS team will review your treatment regularly to see if it is still effective. We will also monitor how you are managing any side effects and ensure there are no complications. Please see appointments and clinics section for more information about appointments related to DMDs.
Please note that by commencing on a DMD you are agreeing to have safety monitoring for that drug. This will include attendance at appointments with the consultant and nurse/practitioner, and having blood tests and other monitoring when required. The appointments and tests for safety monitoring are required for the ongoing prescription of this medication. If you miss appointments or tests, it is likely that your DMD medication may be stopped.
Travel
Different countries have different regulations about medications that can be brought into their country. It is important to check the rules for each country you will visit before traveling, even if you are only passing through.
When traveling with MS drugs, keep them in their original packaging. Your medications must be kept in your hand luggage.
To travel with medication and/or syringes, you must have a letter from the MS team. This ensures your medication will pass through customs and can go into another country. Make sure you give the MS team plenty of notice when requesting a travel letter. This can be done by emailing the MS helpline with your passport number and travel dates.
When traveling with injectables that need to be refrigerated, it is recommended that you put them in an insulated bag with a freezable ice pack. When travelling on a long haul flight, we recommend contacting the airline to see if your injectable can be stored in the aircraft refrigerator.
If the medication needs to be stored in a fridge, or you are going somewhere where the room temperature is likely to be above 25°C, talk to your travel company before you leave to make sure you will have access to a fridge. Many drugs shouldn't go above a certain temperature and can’t be put back in a fridge once they have warmed up.
Vaccinations
People with MS are generally encouraged to have vaccinations which are part of the national vaccination programmes. When travelling abroad, vaccinations are often recommended. See here for more information Travel vaccination advice - NHS.
Non-live vaccines are generally considered safe for people with MS, including those taking a DMD. Depending on the DMD that you are taking, it may be recommended that the vaccine is timed around your DMD treatment.
People on certain DMD treatments, cannot have live vaccines as they are immunosuppressed. If you have any queries about this, please contact the MS Service on 0300 019 2362 or This email address is being protected from spambots. You need JavaScript enabled to view it..
Other resources
Disease modifying drugs (DMDs) | MS Trust
Guide to decision making | MS Trust
