Real-World Data Support High-Efficacy vs Low-Efficacy DMTs in Relapsing-Remitting MS

Results from a retrospective 1:1 propensity score-matched cohort study published in Frontiers in Neurology provide real-world support for broader use of high-efficacy disease-modifying therapies (HE DMTs) in relapsing-remitting multiple sclerosis (RRMS). Using routine clinical data from a German tertiary MS center (Jena University Hospital), researchers found that patients on HE DMTs had significantly lower relapse rates, reduced MRI activity, and greater treatment persistence compared with those on low-efficacy (LE) DMTs.

The study included data from adults with RRMS who initiated HE DMTs (n=238) or LE DMTs (n=246) between 2007 and 2022. HE DMTs included Gilenya (fingolimod; Novartis, Basel, Switzerland), Zeposia (ozanimod; Celgene, Summit, NJ), Mavenclad (cladribine; Merck, Darmstadt, Germany), Tysabri (natalizumab; Biogen, Cambridge, MA), Lemtrada (alemtuzumab; Sanofi, Paris, France), Ocrevus (ocrelizumab; Genentech, San Francisco, CA), and Kesimpta (ofatumumab; Novartis, Basel, Switzerland). LE DMTs included beta-interferons, glatiramer acetate, dimethyl/diroximel fumarate, and Aubagio (teriflunomide; Sanofi, Paris, France). After 1:1 propensity score matching, 133 observations for each treatment group were analyzed (with a median follow-up time of 24 months for LE DMTs and 43 months for HE DMTs). The primary outcome was annualized relapse rate (ARR), and secondary end points included relapse hazard, MRI activity, loss of no evidence of disease activity (NEDA-3) status, 3-month confirmed disability progression (CDP), and treatment discontinuation.

Key findings included:

• ARR was 64% lower with HE DMTs than LE DMTs (0.13 vs 0.37; rate ratio 0.36; 95% CI, 0.23 to 0.53; P<.001).
• Relapse hazard was 59% lower with HE DMTs (hazard ratio [HR], 0.41; 95% CI, 0.28 to 0.60; P<.001).
• MRI activity hazard was 63% lower with HE DMTs (HR, 0.37; 95% CI, 0.26 to 0.53; P<.001).
• NEDA-3 loss hazard was 53% lower with HE DMTs (HR, 0.47; 95% CI, 0.35 to 0.64; P<.001).
• No significant difference in CDP was observed between treatment groups.
• Treatment discontinuation hazard with HE DMTs was 87% lower in the first year (HR, 0.13; 95% CI, 0.04 to 0.36; P<.001) and 67% lower thereafter (HR, 0.33; 95% CI, 0.21 to 0.50; P<.001) compared with LE DMTs.

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