Is my DMT working?

[MRomanow]

Happy Mother's Day. I hope you had a nice day.

So I started Aubagio April 24th after 5 and 1/2 years on Betaseron. I do not see many side effects (hair loss (already bald) or diarrhea) but my wife feels like I am going down hill. (Balance is off, weakness in left hand has gotten worse). I know these DMTs are supposed to slow down progression, right.

So how long do you give a new medication before looking at something else? I wanted to do Tysabri but I was JC Positive (I was on the high level).

[jreagan70]

Hi MRomanow:

DMTs slow progression by reducing the number of relapses. A med can be judged as effective if the person has fewer relapses on the med than a person who isn't taking the med.

People not on a DMT have an average of about one relapse per year. So if the person on the med has fewer than that, it can be argued that the med is effective in slowing relapses, thereby slowing progression. Of course that has to be put into the context of the individual. Did that have something to do with why you switched from Betaseron?

Do you mean that you've gone downhill in just the 2 weeks you've been on Aubagio? Do you believe you're having a relapse since changing meds? How long was your washout period between Betaseron and Aubagio? If you think you're having an actual relapse, it would be best to consult your neuro.

Two weeks isn't enough time to judge the effectiveness of a DMT. Two weeks isn't enough time for any DMT to get up to speed enough to stop a full-blown relapse. Even Tysabri allows up to 6 months to judge results.

In the clinical trials, Aubagio didn't show a difference from placebo in disability progression until about the 6-week mark. (The curves are in the prescribing information.)

If you've been going downhill only in the 2 weeks you've been on Aubagio, it's possible that what you're experiencing are side effects of the med and not a relapse or progression. You'll have to talk to your neuro about it. But onset of symptoms or worsening of symptoms that correspond in time with the starting of a new med are highly suspicious for side effects.

As far as slowing progression, the keyword appears to be slowing, not stopping. In clinical testing, Aubagio appeared to hold disability status for only for the first 12 weeks. After that, progression of disability continued, but it was slower than for placebo. How that applies to you specifically is something to discuss with your neuro.

No MS DMT has been shown to stop progression of neuronal degeneration, the process that leads from RRMS to SPMS and predominates in PPMS. They only slow the inflammatory relapses that start the damage that leads to the subsequent neurodegeneration. If you're progressing even though you're not having relapses, DMTs don't help with that.

Sounds like it's time for a talk with your neuro about what's going on specifically with you.