Choosing initial MS therapy; personal, disease, and medication factors

Initiating disease modifying therapy in a patient with newly diagnosed relapsing multiple sclerosis currently offers the best opportunity to influence their subsequent disease course. This article reviews personal factors, disease presentation characteristics, and data on current disease modifying therapies from the perspective of choosing initial treatment in this setting. Although metrics for prognostication at the individual level remain unreliable, particularly for those with mild presentations, currently available data on the relative efficacy of disease modifying therapies supports offering high efficacy therapy first line to most patients with newly diagnosed relapsing multiple sclerosis.

• Publication year

  2025

• Venue

  Neurotherapeutics

• Publication date

  2025-04-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.1016/j.neurot.2025.e00582PMID 40221354PMCID 12418410
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Long-Term Treatment With Ocrelizumab in Patients With Early-Stage Relapsing MS

  2025cited by this paper
• Earlier Initiation of Ublituximab Treatment Is Associated with Improved Disability Outcomes Among Treatment Naïve Participants in ULTIMATE I and II (P9-6.001)

  2024cited by this paper
• Current and future role of MRI in the diagnosis and prognosis of multiple sclerosis

  2024cited by this paper
• OCARINA II, Phase III Study: Results of Subcutaneous Ocrelizumab Administration in Patients with Multiple Sclerosis (S31.006)

  2024cited by this paper
• Effectiveness of cladribine compared to fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting multiple sclerosis

  2024cited by this paper
• 10 Years of Ocrelizumab Treatment in Multiple Sclerosis: Long-term Efficacy and Safety Clinical Trial Data (S31.005)

  2024influential reference
• Longer-term (Up to 6 Years) Efficacy of Ofatumumab in People with Recently Diagnosed and Treatment-naive Relapsing Multiple Sclerosis (S31.003)

  2024cited by this paper
• COMBAT‐MS: A Population‐Based Observational Cohort Study Addressing the Benefit–Risk Balance of Multiple Sclerosis Therapies Compared with Rituximab

  2024cited by this paper
• Drugs Targeting CD20 in Multiple Sclerosis: Pharmacology, Efficacy, Safety, and Tolerability

  2024cited by this paper
• Emerging Cerebrospinal Fluid Biomarkers of Disease Activity and Progression in Multiple Sclerosis

  2024cited by this paper
• Sphingosine 1‐phosphate receptor modulators in multiple sclerosis treatment: A practical review

  2024cited by this paper
• Insights for Healthcare Providers on Shared Decision-Making in Multiple Sclerosis: A Narrative Review

  2024cited by this paper
• Practical Considerations for Managing Pregnancy in Patients With Multiple Sclerosis

  2024influential reference
• Prognostic models for predicting clinical disease progression, worsening and activity in people with multiple sclerosis.

  2023cited by this paper
• Highly Effective Therapy Versus Escalation Approaches in Early Multiple Sclerosis: What Is the Future of Multiple Sclerosis Treatment?

  2023cited by this paper
• Teriflunomide and Time to Clinical Multiple Sclerosis in Patients With Radiologically Isolated Syndrome: The TERIS Randomized Clinical Trial.

  2023cited by this paper
• Rituximab vs Ocrelizumab in Relapsing-Remitting Multiple Sclerosis.

  2023cited by this paper
• Clinical Validation of a Multi-protein, Serum-based Assay for Disease Activity Assessments in Multiple Sclerosis

  2023cited by this paper
• Serum Glial Fibrillary Acidic Protein Compared With Neurofilament Light Chain as a Biomarker for Disease Progression in Multiple Sclerosis.

  2023cited by this paper
• Postpartum relapse risk in multiple sclerosis: a systematic review and meta-analysis

  2023cited by this paper
• Association of Serum Neurofilament Light Chain Levels at Disease Onset With Disability Worsening in Patients With a First Demyelinating Multiple Sclerosis Event Not Treated With High-Efficacy Drugs.

  2023cited by this paper
• Early non-disabling relapses are important predictors of disability accumulation in people with relapsing-remitting multiple sclerosis

  2023cited by this paper
• Individual Differences in the Patient Experience of Relapsing Multiple Sclerosis (RMS): A Multi-Country Qualitative Exploration of Drivers of Treatment Preferences Among People Living with RMS

  2023influential reference
• Serum glial fibrillary acidic protein and disability progression in progressive multiple sclerosis

  2023cited by this paper
• Frequency and risk factors of rebound after fingolimod discontinuation - A retrospective study.

  2023cited by this paper
• Neurofilament Light Chain Elevation and Disability Progression in Multiple Sclerosis.

  2023cited by this paper
• Safety and efficacy with alemtuzumab over 13 years in relapsing-remitting multiple sclerosis: final results from the open-label TOPAZ study

  2023cited by this paper
• Secondary hypogammaglobulinemia in patients with multiple sclerosis on anti-CD20 therapy: Pathogenesis, risk of infection, and disease management.

  2023cited by this paper
• Immune-mediated colitis associated with ocrelizumab: A new safety risk

  2023cited by this paper
• The impact of medical insurance on health care access and quality for people with multiple sclerosis in the United States: A scoping review

  2023cited by this paper
• Effect of Dimethyl Fumarate vs Interferon β-1a in Patients With Pediatric-Onset Multiple Sclerosis

  2022influential reference
• Associations of sNfL with clinico‐radiological measures in a large MS population

  2022cited by this paper
• Dimethyl Fumarate Delays Multiple Sclerosis in Radiologically Isolated Syndrome

  2022cited by this paper
• Serum GFAP and NfL Levels Differentiate Subsequent Progression and Disease Activity in Patients With Progressive Multiple Sclerosis

  2022cited by this paper
• High-Efficacy Therapies for Treatment-Naïve Individuals with Relapsing–Remitting Multiple Sclerosis

  2022cited by this paper
• Updates and advances in multiple sclerosis neurotherapeutics

  2022cited by this paper
• Cryptococcal Meningitis Reported With Fingolimod Treatment

  2022cited by this paper
• Ublituximab versus Teriflunomide in Relapsing Multiple Sclerosis.

  2022cited by this paper
• Long-term safety and efficacy of ozanimod in relapsing multiple sclerosis: Up to 5 years of follow-up in the DAYBREAK open-label extension trial

  2022cited by this paper
• Comparison of switching to 6-week dosing of natalizumab versus continuing with 4-week dosing in patients with relapsing-remitting multiple sclerosis (NOVA): a randomised, controlled, open-label, phase 3b trial.

  2022cited by this paper
• Long-term efficacy and safety of siponimod in patients with secondary progressive multiple sclerosis: Analysis of EXPAND core and extension data up to >5 years

  2022cited by this paper
• How patients with multiple sclerosis acquire disability

  2022cited by this paper
• OUP accepted manuscript

  2022cited by this paper
• Sphingosine 1-Phosphate Receptor Modulators for Multiple Sclerosis

  2021cited by this paper
• Ponesimod Compared With Teriflunomide in Patients With Relapsing Multiple Sclerosis in the Active-Comparator Phase 3 OPTIMUM Study

  2021influential reference
• Predicting disability worsening in relapsing and progressive multiple sclerosis

  2021cited by this paper
• Initial treatment strategy and clinical outcomes in Finnish MS patients: a propensity-matched study

  2021cited by this paper
• Incidence and Risk of Infection Associated With Fingolimod in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis of 8,448 Patients From 12 Randomized Controlled Trials

  2021cited by this paper
• Age and sex as determinants of treatment decisions in patients with relapsing-remitting MS.

  2021cited by this paper
• An updated review of teriflunomide's use in multiple sclerosis.

  2021cited by this paper
• Long-term safety and efficacy of dimethyl fumarate for up to 13 years in patients with relapsing-remitting multiple sclerosis: Final ENDORSE study results

  2021cited by this paper
• Sphingosine 1-phosphate receptor modulators in multiple sclerosis and other conditions.

  2021cited by this paper
• "I'm walking into the unknown": Qualitative insights into how emotions and lived experience related to multiple sclerosis diagnosis impact on decisions to pursue disease modifying treatment.

  2021cited by this paper
• Health Disparities, Inequities, and Social Determinants of Health in Multiple Sclerosis and Related Disorders in the US: A Review.

  2021cited by this paper
• Association of Disease Severity and Socioeconomic Status in Black and White Americans With Multiple Sclerosis

  2021cited by this paper
• Progressive multifocal leukoencephalopathy in dimethyl fumarate-treated multiple sclerosis patients

  2020cited by this paper
• Natalizumab in Multiple Sclerosis Treatment: From Biological Effects to Immune Monitoring

  2020cited by this paper
• Long-term safety and efficacy of teriflunomide in patients with relapsing multiple sclerosis: Results from the TOWER extension study.

  2020cited by this paper
• Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational cohort study.

  2020cited by this paper
• Plasma neurofilament light levels are associated with risk of disability in multiple sclerosis

  2020cited by this paper
• Prognostic models for predicting clinical disease progression, worsening and activity in people with multiple sclerosis

  2020cited by this paper
• Initial high-efficacy disease-modifying therapy in multiple sclerosis

  2020cited by this paper
• Five years of ocrelizumab in relapsing multiple sclerosis

  2020cited by this paper
• Ofatumumab versus Teriflunomide in Multiple Sclerosis.

  2020cited by this paper
• Long-term follow-up from the ORATORIO trial of ocrelizumab for primary progressive multiple sclerosis: a post-hoc analysis from the ongoing open-label extension of the randomised, placebo-controlled, phase 3 trial.

  2020cited by this paper
• Efficacy and Safety of 2 Fingolimod Doses vs Glatiramer Acetate for the Treatment of Patients With Relapsing-Remitting Multiple Sclerosis

  2020cited by this paper
• Effect of ocrelizumab on vaccine responses in patients with multiple sclerosis

  2020cited by this paper
• Should frequent MRI monitoring be performed in natalizumab-treated MS patients? A contribution to a recent debate

  2020cited by this paper
• Serum Neurofilament Light Chain Levels in Patients With Presymptomatic Multiple Sclerosis.

  2020cited by this paper
• Infection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies.

  2020cited by this paper
• Effect of Disease Modifying Therapy on Disability in Relapsing-Remitting Multiple Sclerosis Over 15 Years.

  2020cited by this paper
• Association of Initial Disease-Modifying Therapy With Later Conversion to Secondary Progressive Multiple Sclerosis

  2019influential reference
• Understanding treatment decisions from the perspective of people with relapsing remitting multiple Sclerosis: A critical interpretive synthesis.

  2019cited by this paper
• Patients' preferences and willingness-to-pay for disease-modifying therapies.

  2019cited by this paper
• Current therapeutic landscape in multiple sclerosis: an evolving treatment paradigm

  2019cited by this paper
• Blood neurofilament light chain as a biomarker of MS disease activity and treatment response

  2019cited by this paper
• Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (SUNBEAM): a multicentre, randomised, minimum 12-month, phase 3 trial.

  2019cited by this paper
• Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (RADIANCE): a multicentre, randomised, 24-month, phase 3 trial.

  2019cited by this paper
• Early clinical markers of aggressive multiple sclerosis.

  2019influential reference
• Predicting the profile of increasing disability in multiple sclerosis

  2018cited by this paper
• Safety and efficacy of cladribine tablets in patients with relapsing–remitting multiple sclerosis: Results from the randomized extension trial of the CLARITY study

  2018cited by this paper
• Multiple sclerosis

  2018influential reference
• Progressive multifocal leukoencephalopathy after fingolimod treatment

  2018cited by this paper
• Comparative Effectiveness of Rituximab and Other Initial Treatment Choices for Multiple Sclerosis

  2018cited by this paper
• Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis

  2018cited by this paper
• Multiple Sclerosis

  2018cited by this paper
• Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomised, phase 3 study.

  2018cited by this paper
• B‐cell Therapy for Multiple Sclerosis: Entering an era

  2018cited by this paper
• Probability discounting of treatment decisions in multiple sclerosis: associations with disease knowledge, neuropsychiatric status, and adherence

  2018cited by this paper
• Serum GFAP as a biomarker for disease severity in multiple sclerosis

  2018cited by this paper
• Mortality from Listeria monocytogenes meningoencephalitis following escalation to alemtuzumab therapy for relapsing-remitting Multiple Sclerosis.

  2018cited by this paper
• Alemtuzumab CARE-MS I 5-year follow-up

  2017cited by this paper
• Immunological and pathological characterization of fatal rebound MS activity following natalizumab withdrawal

  2017cited by this paper
• Shared Decision Making and Autonomy Among US Participants with Multiple Sclerosis in the NARCOMS Registry.

  2017cited by this paper
• Comparison of preferences of healthcare professionals and MS patients for attributes of disease‐modifying drugs: A best‐worst scaling

  2017cited by this paper
• Prognostic indicators in pediatric clinically isolated syndrome

  2017cited by this paper
• Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis

  2017cited by this paper
• Ocrelizumab versus Interferon Beta‐1a in Relapsing Multiple Sclerosis

  2017cited by this paper
• Shared decision-making in multiple sclerosis

  2017cited by this paper
• Hispanic Americans and African Americans with multiple sclerosis have more severe disease course than Caucasian Americans

  2017cited by this paper

• Special Edition: Therapeutic advances in multiple sclerosis

  2025cites this paper
• Liraglutide Attenuates Disease Severity in Experimental Autoimmune Encephalomyelitis by Modulating Splenic T Helper Cell Subsets

  2025cites this paper