How to Choose the Right Multiple Sclerosis Treatment for Your Lifestyle: A Practical Guide for Patients

 Multiple Sclerosis (MS) is a complex autoimmune disease that affects the central nervous system, often with highly individualized symptoms and an unpredictable course.

Thanks to advances in modern medicine, patients now have access to a wide range of disease-modifying therapies (DMTs) designed to slow disease progression, reduce relapse frequency, and improve long-term quality of life. But this abundance of treatment options creates another kind of challenge—how do you know which one is right for you?

In clinical practice across the United States, newly diagnosed MS patients are typically encouraged to start a DMT soon after diagnosis. These treatments fall into three main categories: injectable medications, intravenous infusions, and oral pills. While they all serve the same basic goal—modifying the immune system to reduce disease activity—the mode of administration and lifestyle compatibility vary greatly.

Injectable medications, such as interferon beta products (e.g., Avonex, Rebif), were long considered the frontline therapy. These can be administered by the patient at home on a regular schedule—usually weekly or every few days. Many patients find empowerment in taking control of their own treatment. However, over time, "injection fatigue" can set in. A cross-sectional study by the American Academy of Neurology found that approximately 22% of patients became less adherent to their treatment within the first year, often due to discomfort or the psychological toll of regular injections.

For these individuals, infusion therapy has become an increasingly popular alternative. Drugs like Ocrevus and Tysabri are administered via IV in a clinical setting, sometimes as infrequently as once every six months. For moderate to severe MS or those with frequent relapses, these medications can be highly effective. One patient, a 32-year-old professional based in Palo Alto, California, struggled to stay on schedule with oral pills due to frequent travel. After switching to Ocrevus, her relapse rate declined dramatically, and her MRI scans showed fewer active lesions. She appreciated not having to think about her MS every day—her treatment was handled a few times a year in a controlled, professional setting.

Oral medications have rapidly gained traction in recent years, especially with drugs like Tecfidera (dimethyl fumarate), Aubagio (teriflunomide), and Vumerity. The convenience of taking a pill daily has made these options particularly attractive, especially during the COVID-19 pandemic when many sought to avoid frequent clinical visits. A high school teacher in Brooklyn shared that her life became "significantly more manageable" after switching from injections to a daily oral DMT. That said, oral medications aren’t without their risks. Some can affect liver function or lead to gastrointestinal side effects, so regular blood work is often required.

Choosing the right treatment isn’t purely a medical decision—it’s a lifestyle decision. In our clinics, we ask patients a wide array of practical questions: Do you have a flexible work schedule? Are you comfortable administering injections? Do you have someone at home to help? How close are you to a treatment center? Can you afford co-pays or out-of-pocket costs?

In the U.S., treatment often begins with several “pre-treatment evaluations.” For example, patients considering Tysabri must be screened for JC virus antibodies, due to the risk of progressive multifocal leukoencephalopathy (PML), a rare but serious brain infection. For Ocrevus, physicians typically evaluate liver function, complete blood counts, and vaccine history. Vaccinations such as the shingles vaccine are often recommended before treatment begins because once the immune system is suppressed, the body may not respond effectively to vaccines.

There’s also the psychological component to consider. Living with MS means dealing with a chronic, often invisible illness. When a treatment regimen feels disruptive or overwhelming, it can exacerbate feelings of helplessness or depression. On the other hand, a well-matched therapy—one that integrates smoothly into daily life—can foster a sense of control and confidence. This psychological alignment is just as crucial to long-term treatment success as the medication’s clinical efficacy.

Unfortunately, treatment accessibility remains uneven in the U.S., and medication costs can be astronomical. While most FDA-approved DMTs are covered by insurance, coverage varies dramatically between states and plans. For some patients, the choice is not between the best drug and the second-best—but between the drug they need and the drug they can afford.

Ultimately, treating MS is not simply about “finding the best drug.” It’s about finding the right drug for you. That means considering not just what a medication does to your immune system, but how it fits into the life you want to live. As one neurologist at Massachusetts General Hospital put it: “The right treatment isn’t always the strongest one—it’s the one that works with who you are.”

Managing MS is already complex. Treatment shouldn’t make it harder. With open conversations between patients and healthcare providers, and a thoughtful evaluation of lifestyle, psychology, and medical need, it’s possible to choose a therapy that empowers rather than limits. In the end, living with MS doesn’t mean giving up control—it means learning how to regain it, one decision at a time.