The benefits and risks of escalation versus early highly effective treatment in patients with multiple sclerosis

Morgan, Annalisa, Tallantyre, Emma ORCID: https://orcid.org/0000-0002-3760-6634 and Ontaneda, Daniel 2023. The benefits and risks of escalation versus early highly effective treatment in patients with multiple sclerosis. Expert Review of Neurotherapeutics 23 (5) , pp. 433-444. 10.1080/14737175.2023.2208347

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Abstract

Introduction Multiple sclerosis is a chronic, demyelinating, inflammatory, and neurodegenerative disease of the central nervous system that affects over 2 million people worldwide. Considerable advances have been made in the availability of disease modifying therapies for relapsing-remitting multiple sclerosis since their introduction in the 1990s. This has led to debate regarding the optimal first-line treatment approach: a strategy of escalation versus early highly effective treatment. Areas Covered This review defines the strategies of escalation and early highly effective treatment, outlines the pros and cons of each, and provides an analysis of both the current literature and expected future directions of the field. Expert opinion There is growing support for using early highly effective treatment as the initial therapeutic approach in relapsing-remitting multiple sclerosis. However, much of this support stems from observational real-world studies that use historic data and lack safety outcomes or randomized control trials that compare individual high versus low-moderate efficacy therapies, instead of the approaches themselves. Randomized control trials (DELIVER-MS, TREAT-MS) are needed to systemically and prospectively compare contemporary escalation versus early highly effective treatment approaches.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Taylor and Francis Group
ISSN:	1473-7175
Date of First Compliant Deposit:	10 May 2023
Date of Acceptance:	24 April 2023
Last Modified:	29 Apr 2024 10:07
URI:	https://orca.cardiff.ac.uk/id/eprint/159407

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