For relapsing-remitting multiple sclerosis (RRMS), initial treatment with highly effective therapies yields better clinical outcomes at four years than a treatment-escalation approach, a study shows.

“Although escalation therapy is the most accepted treatment strategy for RRMS, it is not evidence based,” Dr Tim Spelman of Karolinska Institute, in Stockholm, and colleagues noted in JAMA Neurology.

They used the Danish and Swedish nationwide multiple sclerosis (MS) registries to see whether there is an association between treatment strategies – therapy escalation vs immediate initiation of highly effective therapies – and disability outcomes.

While both countries have similar socioeconomic standards and healthcare systems, the choice of medications and the treatment strategy for RRMS differ significantly, making it possible to determine whether differences in national MS treatment strategies influence clinical outcomes, they explained.