High-Efficacy MS Therapies Cut Relapses but Fail to Improve Disability Outcomes
In newly diagnosed multiple sclerosis patients, B-cell-depleting and high-efficacy therapies were linked to fewer relapses and reduced brain lesion volume compared with oral platform therapies. However, changes in disability scores and neurofilament light levels were similar across treatment groups after two years. The findings highlight the need for new drugs that target disease progression rather than just inflammation.
The prospective MultipleMS study tracked 509 newly diagnosed patients, revealing that baseline characteristics differed across treatment groups, indicating clinicians selected therapies based on individual patient profiles. This real-world design provides insight into how these drugs perform outside controlled trial settings.
Although stronger treatments reduced acute inflammatory activity, astroglial activation markers remained relatively elevated in those groups. This discrepancy points to persistent chronic central nervous system inflammation, supporting editorial calls for novel agents like Bruton tyrosine kinase inhibitors to target disease progression.
For patients and neurologists, these findings could reshape treatment expectations, suggesting that relapse prevention may not fully halt gradual disability. This may prompt drug developers to prioritize therapies targeting chronic neuroinflammation, potentially yielding new options that better preserve long-term function. It could also influence clinical trial endpoints, shifting focus toward disability progression rather than solely relapse rates, ultimately affecting treatment strategies and patient quality of life.