Patient handout

Relapsing-Remitting Multiple Sclerosis (chronic DMT)

PRODUCTION

1. Your condition

This handout is for relapsing-remitting multiple sclerosis (chronic dmt). Your care team identified this based on: established rrms per mcdonald 2017 (thompson lancet neurol pmid 29275977) — dis + dit confirmed.

Other reasons your team may use this plan: clinically isolated syndrome (cis) — first demyelinating event + mri with risk → start dmt per mcdonald 2017; new t2 lesion or gad+ enhancing lesion on surveillance mri — disease activity (aan 2024); confirmed relapse despite ≥6 mo on dmt → escalation candidate (ectrims 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
glatiramer acetate	20 mg SC daily OR 40 mg SC 3×/week	SC	daily / 3×/week	Long safety track + pregnancy-compatible (Cat B); injection-site reaction common; PRISMS/COPAXONE pivotal
interferon beta-1a	30 mcg IM weekly (Avonex) OR 44 mcg SC 3×/week (Rebif)	IM / SC	weekly / 3×/week	PRISMS — moderate efficacy; flu-like ADRs; LFT + CBC monitoring
dimethyl fumarate	120 mg PO BID × 7 d then 240 mg PO BID	PO	BID	DEFINE (Gold NEJM 2012 PMID 22992073) + CONFIRM — flush + GI ADRs; lymphopenia monitoring; PML rare in lymphopenic
teriflunomide	14 mg PO daily	PO	daily	TEMSO/TOWER — modest efficacy; hepatotoxic; teratogenic (Cat X) — cholestyramine washout required before pregnancy

Plan: RRMS DMT efficacy ladder — moderate vs high efficacy first-line (AAN 2024; ECTRIMS 2024)

3. When to call your provider

Contact your care team if any of the following happen:

Breakthrough relapse on DMT → escalate efficacy tier
PML suspicion on natalizumab → STAT MRI + neurology + d/c
Severe lymphopenia (<500) on DMF → pause + workup
Hepatotoxicity (LFT >3× ULN) on DMT → pause + workup
IgG <500 + recurrent infection on anti-CD20 → IVIG / pause
Severe ARI or COVID → consider hold DMT cycle

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Highly active RRMS — ≥2 relapses in past 12 mo OR ≥3 gad+ lesions OR rapid EDSS progression — aggressive escalation (ECTRIMS 2024)
Breakthrough relapse OR new MRI activity despite ≥6 mo on adequate-dose DMT → escalate to higher efficacy tier (ECTRIMS 2024)
JCV-Ab positivity on natalizumab (especially >2 y therapy + prior IS) → PML risk → switch to anti-CD20 (AAN 2024)(life-threatening)

5. Follow-up

Rehab/PT/OT; symptomatic Rx (spasticity, fatigue, bladder); pregnancy planning + washout when applicable; vaccinations before next DMT cycle; annual MRI; cognitive screen (AAN 2024)

6. Sources

Guideline: AAN 2024 MS DMT guideline + ECTRIMS 2024 + McDonald 2017 (Thompson Lancet Neurol PMID 29275977)