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Starting high efficacy treatment early has shown more favourable long-term outcomes compared with escalation of therapy*1–3

A retrospective cohort study of 4861 patients with RRMS from Sweden and Denmark, initiating their first DMT between 2013–2016, examined the rate of post-baseline 24 weeks CDW between the two groups.§3

Adapted from Spelman T, et al. 2021.

Time to first relapse by treatment-strategy cohort3

Primary outcome: rate of post-baseline 24 weeks CDW§

There was a significant reduction in the Swedish cohort compared to the Danish one (p=0.004) (HR 0.71; 95% CI: 0.57–0.90)3


Adapted from Spelman T, et al. 2021.

Time to first relapse was delayed in the Swedish cohort with the higher proportion of patients initiating HET early3

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*Better outcomes in terms of CDW, EDSS, ARR and SAD.1–3
Denmark, N=2161; Sweden, N=2700.3
DMT initiated between 1 January 2013 and 31 December 2016. Data were extracted from MS registries on 2 October 2019 (i.e. an observational time of 3–7 years).3
Time to 24-week CDW was defined as an increase in EDSS score with at least 1 point from baseline (defined as the date that DMT was first started), sustained between two follow-up visits separated by no less than 6 months (1.5 points if the EDSS score at baseline was 0 and 0.5 points if the baseline EDSS score was ≥5.5). Time to 24-week CDW was based on an increase in EDSS that was dependent on the baseline EDSS.3
First-line (low–moderate efficacy) DMTs were interferon beta-1a, -1b, pegylated interferon beta-1a, glatiramer acetate, teriflunomide and dimethyl fumarate. Second-line (moderate–high efficacy) DMTs were natalizumab, fingolimod▼, ocrelizumab, rituximab and alemtuzumab.3 Rituximab is not licensed for MS in the UK. Novartis does not endorse the off-label use of any medicines.

ARR, annualised relapse rate; CDW, confirmed disability-worsening; CI, confidence interval; DMT, disease-modifying therapy; EDSS, Expanded Disability Status Scale; HET, high-efficacy treatment; HR, hazard ratio; MS, multiple sclerosis; RRMS, relapsing-remitting multiple sclerosis; SAD, sustained accumulation of disability.



  1. Harding K, et al. JAMA Neurol 2019;76(5):536–541.
  2. He A, et al. Lancet Neurol 2020;19:307–316.
  3. Spelman T, et al. JAMA Neurol 2021;78(10):1197–1204 and supplementary material.
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UK | December 2022 | 249561

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