There is no uniform method for selecting initial DMT for patients with relapsing-remitting MS. The following are reasonable options for choosing initial DMT:
- For patients with highly active disease and for patients who place a high value on efficacy and are relatively risk-tolerant, start with highly effective therapy using intravenous natalizumab or a B lymphocyte-depleting agent.
- For patients with less active disease and for patients who value convenience using a self-administered oral medication compared with medications requiring injections or infusions, start with an oral fumarate or sphingosine 1-phosphate receptor modulator.
- For patients who place the highest value on safety and are willing to accept lower effectiveness, start with one of the beta interferons or glatiramer. The response to DMT can be monitored by careful monitoring for acute MS attacks (relapses) and new lesions on brain MRI to ensure effectiveness for the individual patient while minimizing risk.
