Channing: Hi, my name’s Channing. I live in Northwest Arkansas with my dog, Benny, and I was diagnosed with MS 14 years ago. And like so many people, before I began treatment, I had a lot of questions. So today I’m speaking with Dr. Timothy West about some of those questions that I had about the safety risks that are associated with MS treatments. Hi, Dr. West. Thanks so much for chatting with me today.
Dr. West: Hello, Channing.
Channing: So, Dr. West, let’s start by talking about treatment. Risk can have a way of pushing people away from actually starting their treatment because it can be really scary, understandably so. But why is it important for people to discuss treatment risk with their healthcare provider?
Dr. West: Well, there are several factors that affect someone’s treatment decision, including the acceptance of treatment risk. Something that might seem too risky to one person, might be completely okay to another. So it’s important that they understand how to assess risk and weigh it against the potential benefits of a treatment.
Weighing the benefits and risks of treatment
Channing: So looking back, I would say that I was pretty cautious when it came to treatment. But what was really important to me was the dreams that I still had. So what would you say to someone? How do you discuss treatment with patients who want to avoid any risk?
Dr. West: Yeah, I understand that patients may be scared when they think about the potential risk of a treatment, believe me. Sometimes, I think it’s important to understand that when something traumatic happens to someone, like being diagnosed with a condition like multiple sclerosis, people start to believe that they are somehow unlucky or that they are on a bad streak and bad things are going to continue to happen to them. I try to explain to the patients that in reality we take risks all the time. In fact, by not doing things we take risks. And so the avoidance of risk is not necessarily the idea, it’s really balancing risks. Right? It’s the risk of the treatment that you’re considering versus the risk of the condition getting worse.
Risk from treatment and risk of disease getting worse
Channing: So, Dr. West, it feels like all treatments have some potential risks. Do they?
Dr. West: Well, multiple sclerosis is a disease of the immune system, so treatments for multiple sclerosis are thought to work by changing your immune system. And depending on how that treatment might change your immune system, that may cause certain immune-related side effects. Every treatment has the potential for side effects, and there are pros and cons for each. When considering a treatment, we need to think about the potential risks and potential benefits before making a decision. Does that make sense?
For every treatment, there are pros and benefits vs cons and risks
Channing: It does make sense. Thank you for explaining that. I think it also gives a little bit of background to those who might be new to MS.
Dr. West: Yeah, perfect. I think sometimes we can get confused by the medical terminology, so I like to describe multiple sclerosis in different ways, and I love analogies. And one analogy I often use with my patients is to imagine your body kind of like a castle, and your brain is the queen inside that castle, and we want to protect it at all costs. Your immune system in multiple sclerosis is mistakenly acting like an invader that has breached the castle walls and is now threatening the queen. Now, you have several options on the way to try to protect her. You could summon your pet dragon, and that might cause unnecessary collateral damage. Or you could think about calling out the archers to try and help protect the queen, but that might not be quite as effective depending on the invaders. So when considering your options, the key is balancing the risk of the intervention versus the potential outcomes.
Channing: Okay, that does makes sense! So how would you know how safe or risky a treatment actually is?
Dr. West: Well, there are a lot of things that determine how safe a treatment is. We look at data from clinical trials and from real-world experiences to understand the types of side effects that can happen with each treatment. We look to see how severe these side effects are and how often they occur. It’s also important to know whether there are ways that we can monitor for certain side effects, so if we see that things are heading in the wrong direction, we can try to manage those side effects, and if needed, find a different solution that may work for you.
Treatment safety is determined by:
- Clinical trial data
- Real-world experiences
- Side effect severity
- Side effect frequency
It’s important to monitor for side effects and find a new solution if needed.
Channing: Well, it’s really nice to know that there are ways to monitor side effects, and then also help reduce potential risks.
Dr. West: Right. With multiple sclerosis, the first thing we are really trying to do is prevent further damage to your brain. But the second thing we want to do is reduce the risks from the treatment as best as we can by trying to anticipate them and respond to them.
Channing: Awesome. Well, thank you so much, Dr. West, for answering these questions about treatment risk. It’s been really educational for me.
Dr. West: Of course, Channing. Always a pleasure.
Channing: After speaking with my doctor, and being open about my concerns, I feel like I had a better understanding about the treatment risk. And that in turn helped me decide on a treatment that I was comfortable with and that was appropriate for me.
Everyone’s experience with multiple sclerosis (MS) is different. Your healthcare provider should always be your primary source of information. The people in this video are paid spokespeople for Biogen.