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MS – Early Intensive Treatment Strategy — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS – Early Intensive Treatment StrategySCE Neurology

A 45-year-old man with newly diagnosed RRMS is discussed at the MDT. His neurologist explains the concept of 'treatment escalation' versus 'early intensive treatment'. What does current evidence favour for patients with active RRMS?

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Correct answer: E — Starting with a high-efficacy DMT early in the disease course

Increasing evidence supports early initiation of high-efficacy DMTs (such as ocrelizumab, natalizumab, or alemtuzumab) over the traditional escalation approach, as early treatment may better preserve neurological reserve and prevent irreversible disability accumulation. Observational studies (e.g., from Swedish and Danish registries) show that patients started on high-efficacy therapies have better long-term disability outcomes. This shift is reflected in updated ABN and NHS England treatment algorithms. A: Escalation strategy may lead to accumulation of irreversible disability. C: Withholding treatment risks progression. D: Steroids do not prevent relapses. E: Combination DMT therapy is not standard.

Reference: ABN MS Guidelines (2022); NHS England MS Treatment Algorithm (2024)