I’ve been having a conversation with someone recently diagnosed about Lemtrada and my opinion for her situation was that Lemtrada offered the closest thing to a cure. And that as she’d made the choice to go for Lemtrada I thought it was a brave choice and the best one she could possibly make.
But your situation is slightly different I think. Since your neurologist isn’t 100% certain you are still RR, but could be progressive, is that likely to affect the outcome of Lemtrada? I don’t know the answer to that question by the way. But I would suggest that’s one to ask.
Generally, the greater the risk involved in the drug, the greater the potential benefits. Which is why for someone newly diagnosed with RR, in my opinion, the best option if offered it is to go for Lemtrada. The reason is that the disease hasn’t done too much damage to your system over years (the way it has to mine over 20 years with mostly no DMDs minimising the damage from relapses). So you have greater resources to get over the severity of the drug action. Your musculature is stronger so if it works as expected, you can recover from the side effects from the drug and just get on with leading an active life.
However, if Lemtrada isn’t going to work as well because you are further down the disease path, then it’s a big risk to take for maybe less reward. And a drug like Tecfidera is much easier to get out of your system if it doesn’t suit you, or if you continue to progress.
Given your options, personally there is no way I would choose a beta interferon like Rebif, Betaferon or Avonex/Plegridy. If I were to opt for an old style injectable, I’d go for Copaxone (interesting that you’ve not mentioned/been offered Copaxone or Plegridy). The reason being that beta interferons often give people flu like symptoms after injecting. Copaxone does not. I took Copaxone for several years without a single side effect. And if you’re going for a drug with a low relapse reduction rate, but also low side effect potential, for me Copaxone wins over an interferon.
Ultimately Iain, I agree with your MS nurse, one of the first two options would be the best choice. But as for the toss us between Lemtrada and Tecfidera, that might be a question you need a bit more information about, even a discussion with your neurologist with regard to how certain he is that Lemtrada would work for you.
Just my thoughts …