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Highly effective disease-modifying treatment as initial MS therapy.

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Starting early with highly effective disease-modifying immunotherapy (DMT) for multiple sclerosis (MS) is supported by new evidence. Early treatment improves outcomes and reduces irreversible disability, with manageable risks making it a viable first-line strategy for people with MS.

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Area of Science:

  • Neurology
  • Immunology
  • Pharmacology

Background:

  • Highly effective disease-modifying immunotherapy (DMT) is increasingly used for multiple sclerosis (MS).
  • Ten highly effective DMTs are now available, though access may vary.
  • Evidence suggests early use of highly effective DMTs (HE DMTs) is superior to gradual escalation.

Purpose of the Study:

  • To review the latest evidence supporting the early use of HE DMTs in people with MS (pwMS).
  • To evaluate if associated risks preclude adopting HE DMTs as a default strategy.

Main Methods:

  • Review of recent clinical evidence and real-world data from MS registries.
  • Analysis of mechanistic insights into DMT efficacy, focusing on B-cell depletion.

Main Results:

  • Real-world evidence indicates early HE DMT is superior to slow treatment escalation, preventing rapid disability accrual.
  • Delaying HE DMT leads to more severe and irreversible disability.
  • B-cell depletion, especially memory B-cell suppression, is a key factor in DMT effectiveness.

Conclusions:

  • The notion that HE DMTs carry high risks is outdated; most have predictable, manageable side effect profiles.
  • Clinicians should consider HE DMTs as a first-line approach for pwMS.
  • Early initiation of HE DMTs is recommended to optimize long-term outcomes in multiple sclerosis management.