What You Need to Know about Risk, Safety, and Tolerability of MS DMTs

If you or a loved one has multiple sclerosis (MS), I hope for treatment with an effective disease-modifying therapy (DMT). It's important to understand the risks, safety, and tolerability of these treatments in order to make an informed decision about your care.
In this video, I’ll be covering what you need to know about the risk, safety, and tolerability of MS DMTs. From potential adverse effects to strategies for managing side effects, I’ve got you covered. Whether you're new to MS treatment or have been on a DMT for a while, this video is a must-watch for anyone looking to maximize the safety and tolerability of their treatment plan.
00:00 Introduction
06:54 Copaxone Side Effects
08:18 Interferon Beta Side Effects
09:37 Aubagio Side Effects
11:38 Fumarate Side Effects
12:51 SP1 Receptor Modulator Side Effects
15:31 Mavenclad Side Effects
17:09 Tysabri Side Effects
18:43 B Cell Depleter Side Effects
20:46 Lemtrada Side Effects
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The Boster Center for Multiple Sclerosis accepts all major insurance carriers and accepts consults from around the globe, both in office and via telemedicine. www.BosterMS.com or call 614-304-3444 to schedule!
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COMMENT with your thoughts and questions below! I look forward to reading and responding!
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NOTE: Make sure to talk to your provider before ANY treatment decision. We hope to educate, empower and energize those impacted by Multiple Sclerosis. This channel consists of a collection of formal lectures and informal video clips about MS to help educate others. These videos do not provide medical advice and are for informational/educational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any of our videos. They are just to help educate you about the condition guys!

[@frankgradus9474]

A very informative rundown of DMTs! "What walks on four legs in the morning, two legs in the afternoon, three legs in the evening?" a man

[@martinm8991]

Avonex: During 5 years, the flu-likes kept constantly increasing, until a just unacceptably extreme level. Tecfidera: During 2 years (on useless Copaxone) before Tecfidera, tons of MS-problems accumulated and increased. Among them a horribly-slow, bad, painful digestion. Well, surprisingly Tecfidera made all those go away, my digestion got much much much better. I did like the occasional blushing. PS: I never missed a single pill in almost 5 years. Tysabri: Took it for 2 years, already after second dose my low blood pressure switched to high blood pressure (which I loved, but doctors did not agree). A whole colony of plantar warts (never had those before) grew on my right foot (none on the left). Ironically: my JC-count changed from medium to zero while on Tysabri. After switching to Ocrevus: warts disappeared in 5 months, blood pressure got back to my usual - unpleasantly low after 18 months. Never had any injection- or infusion-reactions, tadaa. Enjoying my third year on Ocrevus and loving it.

[@helene4717]

Why did you stop Tecfidera, since everything you report was positive? I'm guessing, though you don't mention it, that you started having MS exacerbations, i.e., that effectiveness of Tecfidera wore off.

[@desiredecove5815]

This is a great way to teach people the entirety of the DMD’s- so when given the choices… they can just come here to cut through the BS- get right to the meat & potatoes of it all. I did well for 26 years on Copaxone until it stopped working. Mavenclad has gotten me out of bed and able to function again ( grateful). #Sharingiscaring #MavencladMILF Excellent video with key points only ❤.

[@MysticFIREFLY]

wow - I needed your words today girl....... I too have been on Copaxone since 2009 and now too have to switch to a second line....Mavenclad is my choice as well. Thank you so much.....how did you do on the weeks you took Mavenclad?

[@MysticFIREFLY]

also, did you take the Hep B vaccination, Shinrex and Phnemonia Vaccine before starting Mavenclad?? Lastly - did you take your doses at HOME or were you in a hospital, under watch and care? Any info would be appreciated....

[@kathys8701]

FABULOUSLY informative + IMMENSELY helpful KZbin … you are simply AMAZING Dr Boster. Heartfelt thank yous for all you do to educate + support pwMS 😊

[@chrisc757]

Excellent series, from your videos I have learned more about MS and it’s treatments than you will ever know.

[@graciegladson4960]

Thank you. I went through horrible experience with Tysabri. We didn't know and found out by accident. I kept having clinical decline, no new lesions or activity. No one looked to far. My mom passed and I missed 2 infusions. In 2 months, stuff that I couldn't process was making sense again. My brain was working. They talked me into doing one more infusion and it was less than 24 hours later that my confusion returned. Now I'm on Vumerity. But it still scares me to death.

[@jennymullaney5192]

Thank you for sharing this it's very helpful for a lot of people with MS like myself I will be sharing it on

[@AaronBosterMD]

Glad it was helpful!

[@dougtagg9162]

Thank you for the the video this morning. A good start on Monday morning. Doug coffee in hand from Lyndhurst Ohio.

[@AaronBosterMD]

Morning!

[@tracyfromwv9374]

Crap Gap: my neuro left the med system I'm in, so while I'm trying to find a new neuro and work thru that new assessment and labwork, I am two months behind getting my 6-month dose of Ocrevus. Not fun at all, Dr. B!

[@caraaliseo8586]

Thanks Dr. B!!! You're the best!!! 🔥🔥🔥🔥🔥🔥

[@roberture5903]

Good morning dr. B, thank you for all the information on the dmts, you provided a lot of useful information as always and it is much appreciated. Have a great day sir.

[@stonz42]

Very informative, thanks Dr. B!

[@mariaa6918]

Absolutely fantastic information. Thank you.

[@debbieerickson3731]

Appreciate you Dr. B.

[@zacharychapman3732]

Thank You so so so so much for making the videos, Doc!

[@flybyadebiwood5789]

I’ve learned so much by watching your videos. This series has pulled all the info on drugs together in a nice package. Thank you. What will you do next I wonder? 🤷‍♀️

[@cherylvl1036]

Excellent video again Dr. Boster! I had 3 systemic injection reactions during the 18 months I was taking it. I knew of this reaction before taking copaxone so I didn’t freak out but it was still scary and very uncomfortable. After the 3rd time I became afraid it would happen again so I was happy to switch to another DMT when my neurologist suggested it.

[@famasmaster2000]

Dr Boster , your videos have been so helpful to me. Im on Ocrevus and have had zero reaction to it . I feel very blessed to have tolerated it so well. I'm also on the Wahls diet which has really also been very helpful to me. I love to watch you both. Very inspirational people, THANK YOU 😊 🙏

[@DoctorGretchenHawley]

Wow! This is such an informative video! Well done, per usual☺

[@AaronBosterMD]

Thank you Madam! 😃

[@andreabaldrati9711]

Good morning Dr. B !

[@AaronBosterMD]

Morning!

[@patriciavanderkooy4113]

Excellent video series. While I understand that it was only meant to cover medications, could you comment on the efficacy and potential risks with HSCT (especially as compared to Lemtrada). I believe this is now an important decision which many patients face if Ocrevus isn’t working well.

[@nickynickyproduction]

Big Fan of your videos Aaron, super informative. I’m 24 years old and I was diagnosed with MS 2 weeks ago and symptoms are worsening by the day. I was wondering what your opinion is on Stem cell therapy (HSCT)?

[@jenmiller1081]

Thank you for providing in depth information on each medication. I had my first neurology appointment last month, and the doctor had no interest in answering my questions (on the disease or medications). It felt very rushed. I haven’t filled the rx that he settled on, which was Rebif. He said it was the most ‘natural’ option. The possible side effects don’t scream ‘natural’ lol!

[@Spitfirephotographs]

Happy family day Dr.B Nancy here in Canada 🇨🇦

[@AaronBosterMD]

Good morning!

[@pmooremoore2798]

Wow, excellent video. This entire series is excellent. Do low lymphocytes make someone immunocompromised (0.7 range)?

[@juliehuston2585]

Thank you for all of your work with MS! I appreciate you. When you discussed Ocrevus and Kesimpta, you did not mention PML risk. I am JCV + and this is a concern for me. Can you speak on your opinion of use of theee medications and risk of PML?

[@freethinkeralways]

Thank you for another amazing video, Dr. Boster! Interestingly, MS side effects for cancer meds are the least concerning to oncologists. I'm terrified by the whole philosophy of MS meds with symptoms & side effects worse than symptoms & prognosis of original dx + all these DMTs being far cry from the cure. I know, those are the only tools available & suppose to b "better than nothing"... ☹️

[@annaconsta]

Amazing video! I have to choose between Gilenya and Mavenclad. I was leaning towards Gilenya, but now I am leaning more towards Mavenclad. I have to choose during the next days, I hope I choose right.😅

[@DetroitGoldie]

Great great info! Thank you so much. I am on B cell deleters. That crap gap is REAL. What meds are used to pull through?

[@charlesvan13]

The paradox is that they put you on weak, but risk-free treatments at the beginning. But then give something reasonably effective after a bad symptom. That's not good logic to avoid chronic disability.

[@AaronBosterMD]

Amen!!

[@charlesvan13]

@@AaronBosterMD Granted, there didn't use to be many medicines. It started for me in 2005 and there were only interferon, copaxone and natalizumab which was generally restricted to "nightmare cases".

[@ch3and]

On RTX since two years and doing well. No medicine is something we want to continue indefinitely

[@gabikynigou2523]

Great information!!! I had MS since 1998 and now dr put me in AUBAGIO! I did all that analysis but just for the first 6 weeks!!! I do have some issue with my hear and I take Hair-vit !Yes my hair get thinner but will pass…hahaha I hope! My balance is the issue!😮

[@vickibrooks905]

Great information! I didn’t realize I was at strike level but my in house pharmacist did. Thankful for her! On my 4th day of Lemtrada my blood pressure skyrocketed to 200/140. Fortunately I was at an infusion clinic at a hospital and was immediately rushed to ER. Waited 2 days for last infusion and blood pressure was fine😅

[@vickibrooks905]

*Stroke

[@freethinkeralways]

♥️ so glad you made it out alive!

[@mkc0005]

Keep up to date appointments with your cardiologist. I went from near zero arterial plaque to a 90% blockage of my main heart artery (LED) within 4 years of my last dose of Lemtrada. Can’t say for sure it was the cause but nothing else in my life changed and the surgeon suggested I must have had some genetic switch flipped to get that bad that fast.

[@jennifer2185]

20:30 Can you do a video (if you haven't yet) about what can be done to help during 'crap gap'?

[@RonaldBeirouti]

Great video! I was always wondering, if we develop iatrogenic autoimmunity following Lemtrada, do we eventually get back to normal or is it for life?

[@zoufi9]

What about Fingolimod or Gilenya ? Interesting in knowing the risks !

[@whoosh_angel]

Dr. Boster PLEASE talk about monomethyl fumarate (BAFIERTAM) it came out in 2020 without the GI upset side effects of the earlier fumerates.

[@KatBrat38]

Man, crawls in youth, walks in middle age, uses a cane when older, or if me, when on unfamiliar land.

[@ericag2233]

Riddle answer: man walks on 4 legs in the morning, 2 legs in the afternoon and 3 legs in the evening.

[@kelliebutler5307]

Every time I took a Tecfiara pill about 1 hour later I always threw up, about 2 years I did the 3x copaxone and my body got frail , I was on Tysabri for 4 years then I got JC+ ( I had 4 rounds of cemo) , I do Retuxin every 6 months and on my very first dose I had the common infusion reaction so now I take meds before. I get the Crap gap about 1.5-1 months before my next Retuxin ( I feel it now) then I feel much better after about 5 minutes in my infusion.

[@RonaldBeirouti]

The answer to the riddle: a person with MS 😀

[@melissagray3461]

How are we exposed to JP VIRUS and how can we avoid it?

[@megan.0718]

I would like to see a video of the long term effects of DMDs, like what happens in the long term of constantly killing your b cells, are there any studies? Also, a video about the subtle differences in medications that are in the same class, like ocrevus and kesimpta, is one better, or safer than the other, is it better to kill the b cells more often? Or the differences with zemposia and that class. Thanks

[@__Wanderer]

On tecfidera + vumerity --> the white blood cell almost always goes down (30% on average) apparently it is only when it goes down by a critical level causing lymphopenia for extended period that it could cause a problem (from what I have read / understand). :)

[@kaitlyncox6117]

Hi Dr. Boster, is Low Dose Naltrexone worth looking into in addition to a DMT? How does LDN work for MS?

[@frankgradus9474]

Dear Dr Boster, are Mitoxantrone and Cyclophosphamide still on the agenda as possible DMTs in MS?

[@jenigriffiths1004]

I have had a UTI that I have been on Tysabri and last month meningitis. I have decided to stop taking. Is there anything that I can take or do to reduce rebound risk. I am JCV -ve and have had Tysabri for 17 months.

[@halitkhoshen9398]

Dr Boster, does a numbness caused by Aubagio go away after you stop taking that DMT, or does it become permanent? I ask as while on Aubagio I began having numbness issues in my right foot's toes. I was taken off Aubagio and put on Ocrevus, but although two years have passed since stopping Aubagio, I still have the numbness issues (actually, now for more hours each day). I do not know if that was caused by Aubagio or due to a new lesion. FYI, the riddle's answer is "human being."

[@xaroumenotipota]

Do the anti-CD20 ones not have a risk of cancer as well?

[@kevindonnelly7475]

Has anyone analyzed the risk of each medication based on underlying health? That is MS aside if someone is otherwise healthy does the risk if side effect drop? I masking in the context of a recent diagnosis, no comorbidities or underlying issues, would a neuro consider prescribing something more efficacious? I'm not attracted to the idea to failing on subsequent drugs in order to be out on something more efficacious given I'm in good shape, no disability and a very recent diagnosis.

[@capneyeball575]

According to Emo Phillips, it’s a horse! In the morning it has four legs. In the afternoon you chop two of them off and in the evening you glue one back on.

[@Jerusalem_Warrior]

Off subject: My neurologist in Hadassah told me yesterday that recruiting of volunteers for BTK Inhibitor experimentation is dwindling - NOT because they're about to be approved anyway, but because they're not proving themselves so effective (against Ocravus). Any basis for this? 😟

[@martinallenuk]

I had a small MI on the evening I received my 3rd Ocrelizumab infusion. Coronary Artery Spasticity because a thing after a relapse in 2019. I think the steroid that comes with the infusion was the antagonist as I can't take steroids now. But Neurology got scared and blamed Ocrelizumab, a drug that had greatly improved my life. To say I'm angry is an understatement. Tecfidera and Aubagio are trash. Life ain't too good without a B cell killer.

[@heidisweeney9264]

I take Ocrevus infusions and am wondering about the need to wearing masks? Do we still need to wear masks to help us stay well from covid and flu or has that changed? I have heard contrary information.

[@ansi1214]

Dear Dr Boster, If people took Mavenclad or Kesimpta And then have a big surgery. Are there any problems? Thx

[@AlexByrdfurnsculpt]

B cell depleters- "Mount responses to Varicella" what do you mean by that? I apparently had pretty bad Chicken Pox at 3 and I had Shingles at 23.

[@rx6389]

The answer in man. A baby crawls on all four. An adult walks on 2 legs An old person like me walks with 2 legs and a walking stick.

[@zoranagavrilovic9403]

11:16 just now drinking the gross stuff for 11 days to eliminate Aubagio because I'm switching to Kesimpta, I'm not ok 😂

[@dbsxgaming996]

Do i need to be concerned about getting my wife pregnant while i am on Aubagio?

[@Sierravernee87]

I received a call from your client, but I was told that I would have to come to your state. I would love to but I live in Arkansas! But I would love to talk to you and email you my MIR please

[@AaronBosterMD]

ROAD TRIP!

[@Sierravernee87]

@@AaronBosterMD once I can afford it I will! ☺️

[@Sierravernee87]

@@AaronBosterMD can you tell, me is medical marijuana considered a treatment?

[@ntaliantalia7448]

Why suppress the whole immune system and not the exact cause of ms? What is the so called inverse vaccine about? Thank you 😊

[@scottbentz4659]

Human..

[@michel3691]

Man