For people recently diagnosed with multiple sclerosis (MS), early treatment choices were associated with only slight differences after two years, based on the first treatment they used, according to a study published September 9, 2026, in Neurology\u00ae Open Access, an official journal of the American Academy of Neurology. The study found that B-cell\u2013depleting therapies, which are given through an infusion in a vein and lower the number of B cells, a type of immune cell that can play a role in MS, were associated with lower relapse rates and reduced MRI lesion volume compared with oral therapies. While some treatments were associated with fewer relapses and MRI changes, researchers found no differences in disability scores after two years. The study does not prove that one treatment strategy causes better outcomes than another; it only shows associations.<\/p>\n
“People with MS and their doctors have more treatment choices than ever before, but it is still hard to know which treatment to start with,” said study author Fredrik Piehl, MD, PhD, of Karolinska Institutet in Stockholm, Sweden. “The treatment groups already differed in important patient characteristics, suggesting that doctors were to some extent selecting treatments based on the individual patient. Even so, B-cell\u2013depleting therapies and other strong treatments were linked to fewer relapses and fewer MRI changes. But after two years, we did not see clear differences in disability scores.”<\/p>\n
The study involved 509 people with an average age of 33 who were newly diagnosed with relapsing or progressive MS and had not previously received disease-modifying therapy. Participants were followed for two years.<\/p>\n
Participants were grouped by the first treatment they started within six months of the start of the study: 17% received injectable platform therapies; 30% received oral platform therapies; 16% received high-efficacy<\/a> therapies, or stronger MS treatments used when doctors want to control disease activity more aggressively; 20% received B-cell\u2013depleting therapies; and 18% received no treatment.<\/p>\n B-cell\u2013depleting therapies included rituximab and ocrelizumab. High-efficacy therapies included fingolimod, cladribine, natalizumab and alemtuzumab. Oral platform therapies included dimethyl fumarate and teriflunomide. Injectable platform therapies included interferon-beta and glatiramer acetate.<\/p>\n Researchers looked at relapse rate, change in MRI lesion volume and blood levels of serum neurofilament light chain, a biomarker<\/a> of nerve cell injury. They also looked at another biomarker called serum glial fibrillary acidic protein, change in disability scores and whether participants remained on their initial therapy at two years.<\/p>\n The relapse rate was lowest among people taking B-cell\u2013depleting therapies, at 0.04 relapses per year on average, compared with 0.16 for people taking oral platform therapies.<\/p>\n After adjusting for factors such as age, sex and disease duration, people taking B-cell\u2013depleting therapies had a 62% lower relapse rate than those taking oral platform therapies. They did not find an association between high-efficacy therapies and relapse rate.<\/p>\n For MRI findings, B-cell\u2013depleting therapies were associated with a slight reduction in lesion volume, a measure of disease-related brain lesions, compared with oral platform therapies. A similar trend was observed with other high-efficacy therapies, but the difference was not statistically significant.<\/p>\n People taking B-cell treatments were most likely to stay on their first treatment. After two years, 94% of people in this group were still taking it. This compared with 87% of people taking high-efficacy therapies, 72% taking oral platform treatments, 63% who were not treated and 61% taking injectable platform treatments.<\/p>\n However, researchers found no differences between treatment groups in disability score changes at two years. They also found no differences between treatment groups in serum neurofilament light chain levels at two years.<\/p>\n “These findings may help doctors and people with MS talk about what to expect from early treatment,” Piehl said. “No single treatment will be the best choice for everyone, and patient characteristics need to be considered when selecting therapy. Some treatments were linked to fewer attacks and fewer MRI changes, and by following this group for several more years, we will be able to determine whether differences emerge over the longer term.”<\/p>\n A limitation of the study was that people were not randomly put into treatment groups, so the results may have been affected by which treatment they chose.<\/p>\n The study was supported by the European Union, the Swedish Research Council, the Region Stockholm, the Swedish Brain Fund, Erling Perssons Foundation, Knut and Alice Wallenberg Foundation, the German Research Foundation and the Clinical Mass Spectrometry Center Munich.<\/p>\n Source:<\/p>\n American Academy of Neurology<\/a><\/p>\n Journal reference:<\/p>\n