Most people with MS end up on a lot of medication. Mostly prescription.

And the wild part is that many of us weren't "pill people" before diagnosis. Maybe the occasional over-the-counter painkiller for a headache, if that. Then MS shows up and suddenly you're swallowing a handful of pills every day just to function like a recognizable human being. That's not even treating MS itself — that's just managing symptoms well enough to get through the day.

Treating the actual disease is a different story. And even the word treat feels generous, because MS isn't a treat—and it sure as hell isn't fixable —​ yet. However, what we can do is slow it down — reduce the chances of new damage forming. That's where disease-modifying therapies (DMTs) come in.

For many of us, choosing a DMT means deciding how aggressively we want to slow disease activity and progression. The options range from pills, to daily or monthly injections, to infusions — or, for some people at some points, choosing to do nothing at all.

That decision usually comes down to a mix of factors: what you're willing to take, potential side effects, how the medication fits into your life, and how much risk you're comfortable carrying. There's no universal right answer — just tradeoffs

​Disease-Modifying Therapies (DMTs)

Disease-modifying therapies aren't about fixing MS — because we can't do that yet. They're about slowing it down. Specifically, reducing relapse activity and lowering the odds of new damage forming over time.

DMTs come in a few broad flavors: pills, injections, and infusions. Some are considered lower-efficacy with fewer risks. Others are more aggressive and aim to shut down specific parts of the immune system more decisively.

There's no universally "right" choice. For most of us, it comes down to a tradeoff between:

• how aggressive we want to be
• how much risk we're comfortable carrying
• how the medication fits into our actual lives

Below is a high-level look at the major DMT categories — not a recommendation, just context.

DMT	Class	How It Works (High Level)	How Taken
Copaxone	Injectables	Immune decoy / immune modulation	Injection
Interferons	Injectables	Modulates immune signaling	Injection
Gilenya / Ponvory / Zeposia	Oral	Traps immune cells in lymph nodes	Pill
Tecfidera / Vumerity	Oral	Reduces inflammatory immune activity	Pill
Briumvi	CD20 Inhibitor	Depletes circulating B-cells	Infusion
Kesimpta	CD20 Inhibitor	Depletes circulating B-cells	Injection
Ocrevus	CD20 Inhibitor	Depletes circulating B-cells	Infusion
Ocrevus Zunovo	CD20 Inhibitor	Depletes circulating B-cells	Injection

A Closer Look at One Common Approach - CD20 Inhibitors

From here on, this post focuses on one specific group of MS treatments — not because they're "better," but because they're common, effective, and come with experiences people often don't hear explained very well.

These treatments work by targeting B-cells, a part of the immune system that plays a role in MS inflammation.

They don't permanently wipe out your immune system. They temporarily reduce circulating B-cells, which helps lower inflammatory activity. Over time, new B-cells are produced, which is why treatment is repeated on a schedule.

For many people, that level of risk reduction is enough to justify going this route — especially when the alternative is letting MS run unchecked.

What This Means in Real Life

Once you start one of these therapies, the goal is to keep B-cell levels low enough that they're less likely to contribute to MS activity.

But B-cells don't stay gone forever. Your body keeps making new ones. That timing — how fast they come back, how your body reacts, and how close you are to your next dose — is where lived experience starts to matter more than pamphlets.

Below are the most commonly used options in this category.

What is "The Crap Gap"?

Not everyone experiences Crap Gap, and it doesn't show up the same way for everyone. But it's common enough that patients noticed the pattern, named it, and started talking (and yes, bitching) about it — which is pretty warranted considering the amount of bullshit MS already makes us deal with.

Final Note

This post started as a Crap Gap rant—because I'm in one right now (next infusion is six days out, and yes, I'm counting). But while I was pulling together details on these drugs, I realized this is the information I wish I'd been given when I was first diagnosed.

Instead, the experience went like this: "You have MS." Then a stack of glossy drug pamphlets gets shoved into my hands, followed by "Go home and pick one if you want and let me know." No explanation of what any of them actually do. No context. No tradeoffs. Just… homework.

My entire ride home was spent thinking, "Cool. MS—just like I expected—but now I need to fire this neurologist." Because I'm not paying a specialist to assign me a research project they should be able to explain in plain English. If I wanted to crowdsource my medical care, I could've skipped the appointment and gone straight to Google.


So I did what a lot of us end up doing anyway—I became my own research department. I dug through clinical trials, FDA labels, forums, and patient experiences trying to figure out which of these drugs made sense for me. And even then, most of what's out there is numbers and charts. Not reality. Not lived experience. Not the part where you're asking, "Okay, but how wrecked am I going to feel after this?"

This spiraled into more than planned, so it's now a multi-part series. Each post will cover a different DMT category, with a final post pulling everything together into one place. Not recommendations. Not cheerleading. Just explanations that don't assume you have a medical degree or unlimited patience.

For now, this is one slice of the MS treatment landscape—explained like a human.
Because apparently that's asking too much.