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Comparative Study
. 2025 Feb;32(2):e70030.
doi: 10.1111/ene.70030.

Early intensive therapy versus escalation strategy in French Caribbean multiple sclerosis cohort

Thomas David  1   2 , Quentin Lobjois  3 , Benoit Tressières  4 , Aissatou Signaté  3 , Annie Lannuzel  1   2   4   5   6 , Philippe Cabre  3 , Hugo Chaumont  1   2   4   5
Affiliations
Comparative Study

Early intensive therapy versus escalation strategy in French Caribbean multiple sclerosis cohort

Thomas David et al. Eur J Neurol. 2025 Feb.

Abstract

Background: Data on Escalation Therapy versus Early Intensive Therapy (EIT) Strategy in multiple sclerosis (MS) are lacking, particularly in Afro-Caribbean cases, known for their severity.

Objectives: To assess efficacy and safety of these strategies in a predominantly Afro-Caribbean relapsing-remitting MS population.

Methods: A multicenter retrospective study of 195 MS patients, including 66 on EIT, with ≥2 years follow-up.

Primary outcome: Kaplan-Meier curves and log-rank test were used to assess irreversible progression to EDSS scores of 3, 6, and 8.

Secondary outcomes: change in EDSS score, risk factors for EDSS progression, and severe adverse effects.

Results: EIT showed slower EDSS 3 progression than Escalation (median survival 13.5 vs. 9.8 years, p = 0.024). After a median follow-up of 8 years, 89.5% on EIT remained free from EDSS 3 versus 63.8% on Escalation. Univariate analysis linked Escalation (hazard ratio (HR; 95% CI): 2.42 [1.09-5.34]), age at first relapse (HR: 1.04 [1.01-1.06]), incomplete symptom regression (HR: 1.69 [1.02-2.77]), and EDSS 3 progression. EDSS stabilized or decreased with EIT but worsened with Escalation (p < 0.001). Safety profiles were similar.

Conclusions: EIT extends median time to irreversible EDSS 3 in Afro-Caribbean individuals compared to Escalation, supporting its preference as initial treatment.

Keywords: African descent; French Caribbean; disease‐modifying therapies; early intensive therapy; multiple sclerosis.

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Conflict of interest statement

The authors report no relevant disclosures.

Figures

FIGURE 1
FIGURE 1
Patient selection flowchart. EDMUS, European Database for Multiple Sclerosis; EIT, Early Intensive Therapy; HE‐DMT, High‐efficacy disease‐modifying therapy; ME‐DMT, Moderate‐efficacy disease‐modifying therapy; MS, multiple sclerosis; NMOSD, neuromyelitis optica spectrum disorder; PPMS, primary progressive multiple sclerosis; RRMS, relapsing–remitting multiple sclerosis; SPMS, Secondary progressive multiple sclerosis.
FIGURE 2
FIGURE 2
Survival analysis demonstrating the probability of reaching irreversible EDSS 3. EDSS, Expanded Disability Status Scale; EIT, Early Intensive Therapy.
FIGURE 3
FIGURE 3
Survival analysis demonstrating the probability of reaching irreversible EDSS 6 (a), and EDSS 8 (b). EDSS, Expanded Disability Status Scale; EIT, Early Intensive Therapy.
FIGURE 4
FIGURE 4
EDSS variation under treatment. EDSS, Expanded Disability Status Scale; EIT, Early Intensive Therapy.
See this image and copyright information in PMC

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