Highly Effective Therapy Versus Escalation Approaches in Early Multiple Sclerosis: What Is the Future of Multiple Sclerosis Treatment?

Nicole Bou Rjeily; Ellen M Mowry; Daniel Ontaneda; Alise K Carlson

doi:10.1016/j.ncl.2023.06.004

Highly Effective Therapy Versus Escalation Approaches in Early Multiple Sclerosis: What Is the Future of Multiple Sclerosis Treatment?

Neurol Clin. 2024 Feb;42(1):185-201. doi: 10.1016/j.ncl.2023.06.004. Epub 2023 Aug 21.

Authors

Nicole Bou Rjeily¹, Ellen M Mowry², Daniel Ontaneda³, Alise K Carlson⁴

Affiliations

¹ Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA.
² Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA; Department of Epidemiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA.
³ Cleveland Clinic Mellen Center, 9500 Euclid Avenue U10, Cleveland, OH 44195, USA.
⁴ Cleveland Clinic Mellen Center, 9500 Euclid Avenue U10, Cleveland, OH 44195, USA. Electronic address: carlsoa4@ccf.org.

PMID: 37980115
DOI: 10.1016/j.ncl.2023.06.004

Abstract

Treatment options for patients newly diagnosed with multiple sclerosis (MS) are expanding with the continuous development and approval of new disease-modifying therapies (DMTs). The optimal initial treatment strategy, however, remains unclear. The 2 main treatment paradigms currently employed are the escalation (ESC) approach and the early highly effective treatment (EHT) approach. The ESC approach consists of starting a lower- or moderate-efficacy DMT, which offers a potentially safer approach, while the EHT approach favors higher-efficacy treatment early in the disease course, despite a potential increase in risk. Randomized clinical trials aiming to directly compare these approaches in newly diagnosed MS patients are currently underway.

Keywords: Disease-modifying therapy; Eary highly effective therapy; Escalation therapy; Multiple sclerosis; Relapsing-remitting multiple sclerosis.

Publication types

Review

MeSH terms

Disease Progression
Humans
Multiple Sclerosis* / drug therapy
Multiple Sclerosis, Relapsing-Remitting* / drug therapy
Treatment Outcome