Personalizing MS Therapy: Patient Preference and Family Planning Considerations

In this episode, Dr. Williams shifts the discussion to patient-centered decision making. With far more treatment options available today than in the era of platform injectables, patient preference now plays a meaningful role in selecting therapy.

Dr. Bove affirms that patient preference is always part of the conversation, noting that patients bear the risks, costs, and lived consequences of treatment. Within the anti-CD20 class specifically, she explains that choices are somewhat simplified because efficacy is broadly comparable across agents. However, payer coverage may not always align with patient preference — a practical reality that clinicians must address transparently.

Regarding administration format, Dr. Bove notes that some patients prefer a biannual infusion center visit and "being done" with MS treatment for six months; others favor the flexibility of monthly self-injection at home; still others prefer a daily oral option. Each reflects legitimate personal values.

On family planning — one of Dr. Bove's areas of expertise — she emphasizes that the conversation should begin at the very first visit. Women of childbearing potential should hear from the outset that they can plan for the family they want; therapies can be timed and adjusted around conception windows without sacrificing disease control. The field has generated substantial data supporting the use of many disease-modifying therapies (DMTs) around pregnancy, and evolving guidelines continue to refine this guidance.

In the next episode, "First-Line MS Treatment Decisions: Guiding the Newly Diagnosed Patient," Dr. Krieger walks through the clinical and prognostic factors that shape initial therapy selection for a treatment-naive patient with relapsing MS.