A month in the bathroom or injections for life?

I’m exaggerating, of course.  But maybe only a little.

Having been diagnosed with multiple sclerosis, my first disease modifying drug that my doctor chose was Rebif.  From my recent MRI, it seems to have been working well.  Unfortunately, I had an allergic reaction that required me to drop it.  On Friday, I met with my MS neurologist to discuss what we would try next.  My doctor gave me two choices, Copaxone or Tecfidera.

Copaxone is the most prescribed medication for MS.  Until a few days ago, it was a daily sub-cuteaneous injection.  They were just given approval to offer it as a three time a week injection, similar to Rebif.  Copaxone has been around for a while and has a well known risk profile.

Tecfidera is the new kid on the block, being just approved for MS in the USA in March.  A twice a day pill, it works in a different manner than the popular interferon drugs and has had impressive results in studies.  For side effects, many of the users experience flushing and abdominal issues including nausea, abdominal discomfort, vomiting and diarrhea.  The good news is that for most people, these effects occur at the beginning of taking the drug and decrease or disappear over time.  The percentage of people suffering these side effects drops off dramatically going into the second month of use.

So if all else were equal, would I rather have nausea and diarrhea for a month and then have the convenience of just popping a pill twice a day, or not suffer the abdominal issues but be stuck stabbing myself with needles, possible forever?

Out of curiosity I asked that question of my mother, father and wife.  We were aligned by gender.  My mother and wife would opt for the daily injections to not have to suffer the abdominal distress.  My father and I were of the opinion that we could tolerate anything for a month and that would be preferable if it meant not having to give ourselves shots on an ongoing basis.

I chose Tecfidera.  Actually, not because of the pill versus shot question.  Rather because my wife (highly educated in this topic) and I both felt that we liked the science behind how the drug works, and the efficacy, better.  It seems to offer an attractive results vs. risks ratio.

With any luck, I will be part of the half of patients that do not suffer the beginning side effects.  If I’m not that lucky, I will keep an old Rebif syringe on the counter as motivation to stick with it through the adjustment period.

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