When he started his career in medicine over 25 years ago, Dr. Jack Burks had no treatments for his patients with multiple sclerosis (MS). So when the first MS treatment was approved in 1993, he was grateful to finally have something — anything — to prescribe for one of his patients who had a severe form of the disease. Twenty years later, that patient is still doing well on that same medication and has yet to suffer a relapse.
Stories such as this one help demonstrate the impact that progress in research can make on patients’ lives. But Dr. Burks, the chief medical consultant at the Multiple Sclerosis Association of America (MSAA), knows that there are still many unmet needs. Although 15 therapies have been approved for the treatment of MS, none offer a cure, and, as with all treatments, there are potential risks to consider. In this Q&A, Dr. Burks provides his perspectives on the current state of MS treatment and why he remains optimistic about the future.
What is the treatment journey like for people with MS?
“The MS treatment journey for patients can fall into a pretty broad spectrum. For some patients, treatment goes smoothly. The response is excellent, and everything goes well. But for others, it can be a struggle.
“While we have several therapies available, we cannot guarantee that they will work for a particular patient. So we go with what we think will work best, and if it doesn’t work out, we may recommend switching therapies. That change, of course, can be stressful and confusing for patients. But without treatment, the disease will worsen, and patients will only experience further impairment.”
When should a patient and their doctor consider switching therapies?
“Doctors usually recommend changing therapies for one of two reasons: safety or efficacy. Either the patient cannot tolerate the treatment because of side effects, or the treatment is no longer controlling the disease.
“Patients tend to focus more on the side effects. They might not see the brain lesions in magnetic resonance imaging, but they do know if they get sick every time they take a medication. Side effects scare them.
“But switching therapies should not be an immediate reaction to those side effects. If someone has mild injection site reactions, the doctor can recommend applying a warm compress. If they experience gastrointestinal problems, their doctor might suggest taking the medication at a different time of the day.”
What can help smooth out the journey for people with MS?
“A good doctor-patient relationship is essential to managing treatment expectations and side effects alike. Patients need to know and feel that their doctor is looking out for their best interests. Doctors need to understand a patient’s priorities and communicate in a way that builds trust.
“Patients need to become knowledgeable about their disease before their first appointment. They should prepare a list of questions to discuss with their doctor. There are no wrong questions. Doctors and patients should share treatment decisions, which helps patients own their treatment and can improve adherence.”
We’re doing pretty well even though we don’t know the cause of the disease. The future looks very bright for new MS treatments.
How does patient preference factor into MS treatment decisions?
“Doctors need to talk with their patients about their preferences. Some patients do not mind if their treatment is a pill or an injection, while others have stronger opinions.
“Doctors need to understand a patient’s specific concerns because if not, that’s an equation for poor adherence.”
When should doctors bring up MS clinical trials with their patients?
“One of the first questions my patients ask me is ‘What’s new?’ They want to know about the new options that are approved or being developed. So doctors need to know about the trials that are ongoing. I try to focus on trial results, side effects and contraindications with other medications.
“Patients might not be interested in enrolling in a trial, especially if their current treatment is working for them, but often they just want to know what is in the future of MS treatments and how it may affect their treatment down the line.”
What is your view of the future of MS treatment?
“I’m pretty optimistic. We’re doing pretty well even though we don’t know the cause of the disease. The future looks very bright for new MS treatments.
“When I look at these new medications, I consider not only how well a therapy reduces relapse rates, but also the safety profile. Side effects, as I mentioned, are one of the reasons why patients stop taking their medication. Right now, I am reviewing over 20 new therapies that are in trials and have the potential to help so many more people than we already are.”
To learn more about how researchers are studying new MS treatments, read “Relapse Rates: A Benchmark for Measuring MS Treatment Efficacy.”