Choosing MS Medications: What the Latest Research Says and Why Your Choice Matters

If there’s one thing I’ve learned living with multiple sclerosis (MS), it’s that choosing a medication is never simple. 

By: Mariska Breland ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎

There are more options than ever, and the research is always evolving. Should you start on a stronger drug? A milder one? Or skip meds altogether?

Let’s break down what the latest science says — and why your choice matters most.

The Medication Landscape: Strong, Mild, or None?

Stronger Drugs (High-Efficacy DMTs):
These are the heavy hitters — drugs like ocrelizumab (Ocrevus), natalizumab (Tysabri), and cladribine (Mavenclad). They’re designed to aggressively suppress the immune system to slow or stop disease progression. Recent studies, including the “treat early and hard” approach, suggest that starting with a high-efficacy drug may lead to better long-term outcomes, especially for people with highly active or aggressive MS.

Milder Drugs (Moderate/Low-Efficacy DMTs):
Drugs like interferons (Avonex, Rebif), glatiramer acetate (Copaxone), and dimethyl fumarate (Tecfidera) are considered milder. They’re often used for less aggressive MS or as a first step. While they have fewer risks, they may not be as effective at preventing relapses or disability progression.

No Medication:
Some people choose to skip medication, either for personal reasons, concern about side effects, or because their MS is mild. This is a valid choice, but it’s important to weigh the risks: untreated MS can lead to more relapses and faster progression of disability.

What Does the Latest Research Say?

Early, Aggressive Treatment:

A growing body of evidence supports starting with a high-efficacy drug, especially for people with active or aggressive MS. The “treat early and hard” approach is gaining traction, with studies showing better long-term outcomes for those who start strong.

Personalized Medicine:

There’s no one-size-fits-all. Your choice should consider your disease activity, lifestyle, risk tolerance, and personal values.

Monitoring and Adjusting:

Regular MRIs and check-ins with your neurologist are key. If your MS becomes more active, you can always switch to a stronger drug.

My Experience: Skipping Meds and Regret

I’ll be honest: I’ve skipped meds at various points in my MS journey. Sometimes it was because of side effects, sometimes because I felt fine, and sometimes because I just needed a break from being a “patient.”

Looking back, I do regret some of those choices. There were times when my MS was more active than I realized, and I wonder if starting or staying on a stronger drug earlier would have made a difference.

But here’s the thing: I will always stand up for a patient’s right to choose what feels right for them. MS is your journey, and only you know what you can handle — physically, emotionally, and mentally. Your choice matters.

What Should You Consider When Choosing a Medication?

• Disease Activity: How active is your MS? More relapses or lesions mean you might benefit from a stronger drug.
• Side Effects: Are you comfortable with the risks? Some drugs have more serious side effects than others.
• Lifestyle: How often do you want to take medication? Some drugs are daily, some weekly, some monthly, and some just a few times a year.
• Monitoring: Are you willing to have regular blood tests or MRIs?

Personal Values: What matters most to you? Quality of life? Avoiding side effects? Slowing progression at all costs?

Resources and Support

If you’re struggling with the decision, you’re not alone. For more on MS medications and the latest research, check out our Patient Membership and connect with others facing the same choices.

For the most up-to-date information, visit the National MS Society: MS Medications.

Mariska Breland is a prominent Pilates instructor and advocate for those living with neurological conditions. She was diagnosed with multiple sclerosis in 2002 and became a Nationally Certified Pilates teacher shortly afterwards. She is also a breast cancer survivor. Mariska channeled her experiences into creating transformative solutions for teachers and patients. She is notable for her neuro-based workshops, inventing the Fuse Ladder fitness apparatus, and her popular classes on Pilates Anytime. Mariska's current focus is brain-based fitness training and lifestyle guidance for patients and education for providers. She provides resources and strategies for living with neurological conditions through The Neuro Studio.

Photo by Ron Lach