Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jul;22(4):e00582.
doi: 10.1016/j.neurot.2025.e00582. Epub 2025 Apr 10.

Choosing initial MS therapy; personal, disease, and medication factors

Bruce A Cohen  1
Affiliations
Review

Choosing initial MS therapy; personal, disease, and medication factors

Bruce A Cohen. Neurotherapeutics. 2025 Jul.

Abstract

Initiating disease modifying therapy in a patient with newly diagnosed relapsing multiple sclerosis currently offers the best opportunity to influence their subsequent disease course. This article reviews personal factors, disease presentation characteristics, and data on current disease modifying therapies from the perspective of choosing initial treatment in this setting. Although metrics for prognostication at the individual level remain unreliable, particularly for those with mild presentations, currently available data on the relative efficacy of disease modifying therapies supports offering high efficacy therapy first line to most patients with newly diagnosed relapsing multiple sclerosis.

Keywords: Disease modifying therapy; Initial therapy; Multiple sclerosis.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

    1. Reich D.S., Lucchinetti C.F., Calabresi P.A. Multiple sclerosis. N Engl J Med. 2018;378:169–180. - PMC - PubMed
    1. Thompson A.J., Baranzini S.E., Geurts J., Hemmer B., Ciccarelli O. Multiple sclerosis. Lancet Neurol. 2018;391:1622–1636. - PubMed
    1. Kalincik T., Diouf I., Sharmin S., Malpas C., Spelman T., Horakova D., et al. Effect of disease-modifying therapy on disability in multiple sclerosis over 15 years. Neurology. 2021;96:e787–e797. - PMC - PubMed
    1. Montalban X., Hauser S.L., Kappos L., Arnold D.L., Bar-Or A., Comi G., et al. Ocrelizuamb versus placebo in primary progressive multiple sclerosis. N Engl J Med. 2017;376:209–220. - PubMed
    1. Wolinski J.S., Arnold D.L., Brachet B., Hartung H.-P., Montalban X., Naismith R.T., et al. Long term follow-up from the ORATORIO trial of ocrelizumab for primary progressive multiple sclerosis:a post hoc analysis form the on-going open-label extension of the randomized, placebo- controlled, phase 3 trial. Lancet Neurol. 2020;19:998–1009. - PubMed

MeSH terms