Nicoletta asks David what MSers should take into consideration when deciding on a disease-modifying treatment (DMT)? She asks for further details about the DMTs and pregnancy.
David Rog, Consultant Neurologist: Okay. So I think it’s a personal decision and I think it relates to whereabouts the person is in their life at that point and what their aims and objectives are in the foreseeable future, in the first instance. So, for example, if you’re a woman, have you completed your family, are you in a relationship currently and can you see yourself wanting to start a family in the near future. I think occupation is important as well and again, or whether you have dependants, for example. So, to some degree your experience of where MS has taken you so far in terms of relapses and disability and what your key aims are from the treatment. So that sounds a bit woolly, but there is a balance between risk and benefit.
Nicoletta: Could you be a little bit more specific?
David Rog: Absolutely. So in terms of pregnancy, for example, some of the drugs are considered to be safer in pregnancy, although obviously that can never be absolutely guaranteed, and other of the drugs are a real no-no and are contradicated in pregnancy. Some of the drugs have long lasting effects, some of the drugs wear out of the body very quickly and one of the drugs in particular has to actually be actively eliminated from the body or excreted from the body by taking another treatment for up to 11 days. So that’s the first thing. I think also, coming back to the point about people having a lot to lose in the near future, it’s well known now in multiple sclerosis that cognitive deficits occur very early on in the disease, in fact even at the point where no clinical symptoms have been manifest. So those are called, so-called radiologically isolated syndromes. And then the first attack suggestive of MS, a clinically isolated syndrome. Both of those have been associated with cognitive deficits that you also see later on in multiple sclerosis.
So I think the disease modifying treatments can help to preserve cognition and obviously from an occupational perspective, that can be really important depending on what you do. Obviously then you’ve got the risk of relapses and physical disability as well, and so whether it’s an occupational issue or whether you have, for example, if you’re a mother or a father and you have dependants, then your view of the disease modifying treatments might be slightly different. And then you come back to all the traditional things really around route of administration of the disease modifying treatment; is it a tablet, is it an injection, is it a drip or an infusion, how often it’s given, what the blood monitoring requirements and other requirements are, because that’s becoming an increasing issue, I think, for a lot of patients now. And then the general overall benefits in terms of reduction in the rate of relapses and accumulated short term disability from those versus the immediate and the longer term risks of treatment as well. So it’s really whereabouts you are in your own life and family’s life at that point and where your perception of risk versus benefit is in terms of the seesaw, if you like.
Nicoletta: Thank you.
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Dr David Rog is a consultant neurologist at the Salford Royal NHS Trust. He gained his MD in liverpool and he completed his neurological training between 2002 and 2006 on the North West rotation at Lancashire Teaching Hospitals Trust and Greater Manchester Neuroscience Centre. Dr Rog is the Chairman of the Clinical Research Steering Group at Salford Royal and the Nervous System Theme lead for Greater Manchester Comprehensive Local Research Network.