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ECTRIMS 2023 | Early intensive MS treatment versus escalation approach: a comprehensive study

Pietro Iaffaldano, MD, The University of Bari Aldo Moro, Bari, Italy, discusses the results of a research project investigating two treatment strategies for multiple sclerosis (MS): the early intensive treatment, which employs high-efficacy drugs as primary therapy, and the escalation approach, which starts with safer first-line agents like injectables, teriflunomide, or dimethyl fumarate, escalating to high-efficacy disease modifying treatments (DMTs) upon treatment failure. Evidence from randomized control studies and observational studies suggests the superiority of early intensive treatment in reducing disability progression risk. The study analyzed data from 5,000 MS patients and applied a propensity score matching, resulting in two randomized groups. Using linear mixed models for repeated measures and Cox regression models, findings demonstrated that the early intensive treatment approach significantly reduced disability accumulation and risk of reaching a confirmed disability acral event compared to the escalation approach. Therefore, clinicians are advised to initiate high-efficacy DMTs early, especially in patients exhibiting poor prognosis factors. This interview took place at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress 2023 in Milan, Italy.

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