High-efficacy disease-modifying therapies (DMTs) were associated with lower clinical and radiologic disease activity than low-efficacy DMTs in people with relapsing-remitting multiple sclerosis (RRMS), according to a real-world cohort study published in Frontiers in Neurology.

Investigators conducted a retrospective propensity score-matched analysis of routine clinical data from patients initiating DMTs at a tertiary MS center in Germany between 2007 and 2023. High-efficacy therapies included fingolimod, ozanimod, cladribine, natalizumab, alemtuzumab, ocrelizumab, and ofatumumab. Low-efficacy therapies included interferons, glatiramer acetate, fumarates, and teriflunomide. After matching, the analysis included 133 observations in each treatment group.

Key results include the following:

  • Annualized relapse rate was 0.13 with high-efficacy DMTs compared with 0.37 with low-efficacy DMTs, a 64% relative reduction.
  • The hazard of relapse was lower with high-efficacy therapy (HR, 0.41; 95% CI, 0.28-0.60).
  • MRI activity was also lower in the high-efficacy group (HR, 0.37; 95% CI, 0.26-0.53).
  • High-efficacy therapy was associated with lower risk of losing no evidence of disease activity-3 status (HR, 0.47; 95% CI, 0.35-0.64).
  • Three-month confirmed disability progression did not differ significantly between groups.

Treatment discontinuation was less frequent with high-efficacy therapies, with lower hazards both within the first year and after 1 year. No discontinuations due to recurrent infections were reported.

According to the study authors, the findings may support early and broader use of high-efficacy DMTs in MS management. The authors noted that low-efficacy options may remain appropriate in selected situations.

Source: Wich J, Beppler T, Dreiling M, et al. Real-world effectiveness of high-efficacy therapies in multiple sclerosis: a propensity score-matched cohort study. Front Neurol. 2026;17:1773074. doi:10.3389/fneur.2026.1773074