I’ve said it before and some new research prompts me to say it again: when it comes to treating multiple sclerosis (MS), “hit it fast, hit it hard.”
The latest study supporting my belief was published online in advance of the April 2026 issue of Multiple Sclerosis and Related Disorders. Researchers reviewed the records of 1408 patients with relapsing-remitting MS from the Kuwaiti national MS registry who were treated with high-efficacy disease-modifying therapies (DMTs). They found that in the MS battle, quickly starting a DMT had a “significant clinical impact on disease activity and disability.”
After a year of treatment, more than 80% of those patients were relapse-free. More than 75% showed no evidence of disease activity (NEDA-3). Those treated with Ocrevus (ocrelizumab) or Lemtrada (natalizumab) did even better than the overall group. With Ocrevus, 90.6% of patients were relapse-free and 82.7% reached NEDA-3. With Lemtada, the numbers were 88.4% and 81.9%.
There were also significant reductions in Expanded Disability Status Scale (EDSS) scores. Participants treated with Lemtrada had their scores drop by 0.80. The reduction was 0.46 with Ocrevus, and 0.66 for rituximab.
More neurologists are starting the MS battle quickly
Over the past decade, the percentage of neurologists prescribing high-efficacy DMTs as a first-line treatment seems to have grown. Anecdotally, I see it when I scan MS sites on social media. More scientifically, the authors of consensus recommendations published on June 9, 2025, in the Canadian Journal of Neurological Sciences wrote: “It is now recognized that higher efficacy disease-modifying therapies . . . are often required to treat the complex neuropathological changes that occur during the [MS] disease course and improve long-term outcomes.”
After using the Delphi method of developing consensus, these 12 MS experts issued 27 statements. They included:
- Early initiation of an appropriate DMT is recommended to prevent further disease activity that may cause irreversible [central nervous system] damage (81.8% agreement).
- Higher-efficacy therapies are superior at targeting the immune-mediated inflammatory processes, which should slow disability worsening over the longer term (100% agreement).
- Higher-efficacy therapies should be the first choice for all patients with more aggressive or severe disease at presentation (100% agreement).
The high-efficacy DMTs the experts considered were Lemtrada, Ocrevus, Kesimpta (ofatumumab), Tysabri (alemtuzumab), and Mavenclad (cladribine).
“Time is brain”
Dr. Augusto A. Miravalle, a neurologist at Rush University Medical Center in Chicago, Illinois, put it clearly in an interview for the American Medical Association’s “What Doctors Wish Patients Knew” web series: “The big gap now is understanding that in multiple sclerosis—like in many other neurological disorders—time is brain.”
“One misconception is that there is time and patients have time to wait until things get worse before they act,” he said. However, in MS, the best tool we have is prevention, “and that prevention is very effective when used earlier in the course of the disease.”
Reward trumps risk for me
I jumped at the chance to participate in the phase 3 clinical trial of interferon beta-1a Avonex (interferon beta-1a) back in 1994. Since then, I’ve been treated with Tysabri, Aubagio (teriflunomide), and Lemtrada. Two of them, Tysabri and Lemtrada, are considered high-efficacy treatments.
Naturally, all DMTs have risks. Interferon beta-1a was among the first 3 DMTs to become available, so its risks were unknown outside of its clinical trials. Tysabri and Lemtrada have known risks that many would consider pretty significant. With Tysabri the concern is that a very small number of patients taking it have developed progressive multifocal leukoencephalopathy (PML), a rare—but often fatal—brain disease. Lemtrada comes with an increased risk of developing Graves’ disease, hypothyroidism, or immune thrombocytopenia (ITP), among other illnesses.
Yet, from the start of my very first treatment, I’ve believed that with proper patient monitoring, the risks can be mitigated. As for the benefits: Avonex reduced my MS exacerbations. While I was being treated with Tysabri, I felt my progression had slowed. Following my standard 2 courses of Lemtrada, my bladder and bowel functions improved.
For me, the potential rewards of treating MS as quickly as possible, and with the most effective DMT available, have always been worth the possible risks. I’m not the healthy person I was when I was diagnosed over 45 years ago, but my progression could have been much worse had it not been for these treatments.
Hit it fast, hit it hard. (Do you agree?)
(A version of this post first appeared on the Rare Disease Advisor website.)
(Image by harutmovsisyan from Pixabay)
