The initial treatment of MS is at times controversial, with some doctors adocating escalation therapy and others induction therapy or initial treatment with a stronger drug. This Danish study of patients on an MS registry, n= 194 between 2001-2018. Patients were categoroized as taking high efficacy DMT if they took Natalizumab, fingolimod, alemtuzuab, cladribine, daclizumab, or ocrelizumab and low efficacy if they started interferon B, teriflunomide, dimethyl difumarate or glatiramer acetate. Endpoint was confirmed six month disability score on EDSS, and time to first relapse.
Not surprisingly, highly effective DMT group had longer time to first relapse and lower rate of confirmed disability.
Comment- As a cohort study, the paper has significant limitations, but the general idea seems obvious: treat early and hard. Although entrants had to have an entry EDSS of less than 5.5, it is not known if there are subgroups that do just as well on medium intensity treatments.
