{"doi":"10.1002/acn3.70130","title":"Real‐World Comparison of High‐Efficacy Versus Non‐High‐Efficacy Therapies in Multiple Sclerosis","abstract":"<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>The choice of the first disease modifying treatment (DMT) in multiple sclerosis (MS) is a topic of great interest, and whether high‐efficacy DMTs should be the first choice remains debated. We compared treatment outcomes (no evidence of disease activity [NEDA] and its components) between treatment‐naïve relapsing–remitting MS (RRMS) patients commencing high‐efficacy therapies (HET) and non‐high‐efficacy therapies (non‐HET), using propensity score matching.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This is an observational prospective study of two real‐world, single‐centre, longitudinal cohorts: (1) Relapsing–remitting MS (RRMS) patients initiated dimethyl fumarate, fingolimod, glatiramer acetate and natalizumab between 2002 and 2020; (2) RRMS patients initiated ocrelizumab between 2019 and 2021. We selected treatment‐naïve patients and had at least 2 years of follow‐up. We compared the two groups at years 1 and 2 using Cox and Logistic regression models as appropriate.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>After propensity score matching, we included 448 patients: 110 HET and 338 non‐HET. The probability of losing NEDA was 57% and 39% lower in the HET group at year 1 and 2 (HR = 0.43; 95% CI = 0.35, 0.52; <jats:italic>p</jats:italic> &lt; 0.01 and HR = 0.61; 95% CI = 0.45, 0.84; <jats:italic>p</jats:italic> &lt; 0.01, respectively). The probability of relapse in the HET group was 94% and 71% lower at year 1 and 2 (OR = 0.06; 95% CI = 0.01, 0.28; <jats:italic>p</jats:italic> &lt; 0.01 and OR = 0.29; 95% CI = 0.10, 0.84; <jats:italic>p</jats:italic> &lt; 0.02, respectively). The EDSS in the HET group was 30% and 18% lower at year 1 and 2 (Coeff = −0.30; 95% CI = −0.42, −0.18; <jats:italic>p</jats:italic> &lt; 0.01 and Coeff = −0.16; 95% CI = −0.34, 0.02; <jats:italic>p</jats:italic> &lt; 0.09, respectively). The probability of MRI activity in the HET group was 82% lower at year 1 (OR = 0.18; 95% CI = 0.04, 0.86; <jats:italic>p</jats:italic> &lt; 0.03).</jats:p></jats:sec><jats:sec><jats:title>Interpretation</jats:title><jats:p>This study demonstrated that treatment‐naïve RRMS patients should be considered for high‐efficacy therapies based on a greater suppression of disease activity at 2 years.</jats:p></jats:sec>","journal":"Annals of Clinical and Translational Neurology","year":2025,"id":648734,"datarank":0.232493116812815,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"self_citation_contribution":0.20794415416798362,"citation_network_contribution":0.024548962644831394,"self_endowment_contribution":0.20794415416798362,"citer_contribution":0.024548962644831394,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":2,"citers_with_citation_signal":1,"citers_with_endowment":1,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":839117,"name":"Marcello Moccia","orcid":"0000-0003-2613-3090","position":1,"is_corresponding":false},{"id":1397860,"name":"Alessia Bianchi","orcid":"0000-0001-5541-5818","position":2,"is_corresponding":false},{"id":1690811,"name":"Charmaine Yam","orcid":null,"position":3,"is_corresponding":false},{"id":1690813,"name":"Weaam Hamed","orcid":null,"position":4,"is_corresponding":false},{"id":1690815,"name":"Suraya Mohamud","orcid":null,"position":5,"is_corresponding":false},{"id":51077,"name":"Alan J. Thompson","orcid":"0000-0002-4333-8496","position":6,"is_corresponding":false},{"id":242544,"name":"Frederik Barkhof","orcid":"0000-0003-3543-3706","position":7,"is_corresponding":false},{"id":1690818,"name":"Ahmed T. Toosy","orcid":null,"position":8,"is_corresponding":false},{"id":64972,"name":"Olga Ciccarelli","orcid":"0000-0001-7485-1367","position":9,"is_corresponding":false},{"id":1690808,"name":"Sarmad Al‐Araji","orcid":"0009-0007-0703-6849","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Real‐World Comparison of High‐Efficacy Versus Non‐High‐Efficacy Therapies in Multiple Sclerosis","abstract":"<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>The choice of the first disease modifying treatment (DMT) in multiple sclerosis (MS) is a topic of great interest, and whether high‐efficacy DMTs should be the first choice remains debated. We compared treatment outcomes (no evidence of disease activity [NEDA] and its components) between treatment‐naïve relapsing–remitting MS (RRMS) patients commencing high‐efficacy therapies (HET) and non‐high‐efficacy therapies (non‐HET), using propensity score matching.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This is an observational prospective study of two real‐world, single‐centre, longitudinal cohorts: (1) Relapsing–remitting MS (RRMS) patients initiated dimethyl fumarate, fingolimod, glatiramer acetate and natalizumab between 2002 and 2020; (2) RRMS patients initiated ocrelizumab between 2019 and 2021. We selected treatment‐naïve patients and had at least 2 years of follow‐up. We compared the two groups at years 1 and 2 using Cox and Logistic regression models as appropriate.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>After propensity score matching, we included 448 patients: 110 HET and 338 non‐HET. The probability of losing NEDA was 57% and 39% lower in the HET group at year 1 and 2 (HR = 0.43; 95% CI = 0.35, 0.52; <jats:italic>p</jats:italic> &lt; 0.01 and HR = 0.61; 95% CI = 0.45, 0.84; <jats:italic>p</jats:italic> &lt; 0.01, respectively). The probability of relapse in the HET group was 94% and 71% lower at year 1 and 2 (OR = 0.06; 95% CI = 0.01, 0.28; <jats:italic>p</jats:italic> &lt; 0.01 and OR = 0.29; 95% CI = 0.10, 0.84; <jats:italic>p</jats:italic> &lt; 0.02, respectively). The EDSS in the HET group was 30% and 18% lower at year 1 and 2 (Coeff = −0.30; 95% CI = −0.42, −0.18; <jats:italic>p</jats:italic> &lt; 0.01 and Coeff = −0.16; 95% CI = −0.34, 0.02; <jats:italic>p</jats:italic> &lt; 0.09, respectively). The probability of MRI activity in the HET group was 82% lower at year 1 (OR = 0.18; 95% CI = 0.04, 0.86; <jats:italic>p</jats:italic> &lt; 0.03).</jats:p></jats:sec><jats:sec><jats:title>Interpretation</jats:title><jats:p>This study demonstrated that treatment‐naïve RRMS patients should be considered for high‐efficacy therapies based on a greater suppression of disease activity at 2 years.</jats:p></jats:sec>","is_dataset_classified":null,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"40670294","pmcid":"PMC12516238","openalex_id":"https://openalex.org/W4412489329","authors":[],"funders":[{"funder_name":"Multiple Sclerosis Society","grant_id":"Grant Code 92","title":null},{"funder_name":"National Institute for Health and Care Research","grant_id":"RP‐2017‐08‐ST‐004","title":null},{"funder_name":"Multiple Sclerosis Society","grant_id":"10.1","title":null},{"funder_name":"National Institute for Health and Care Research","grant_id":"RP-2017-08-ST-004","title":null},{"funder_name":"Multiple Sclerosis Society","grant_id":"92","title":null}],"total_grants":5,"fwci":1.5181,"citation_percentile":0.8263442,"influential_citations":0,"citation_trend":[{"year":2026,"count":2}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/acn3.70130","host_type":"journal"},{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/acn3.70130","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/pdf/10.1002/acn3.70130","host_type":"publisher"},{"url":"https://doi.org/10.1002/acn3.70130","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/40670294","host_type":"repository"},{"url":"https://discovery.ucl.ac.uk/id/eprint/10216254/","host_type":"repository"},{"url":"https://pure.amsterdamumc.nl/en/publications/f1476665-9319-481b-b2e0-37c92530410a","host_type":"repository"},{"url":"https://doaj.org/article/028023fe2dd34b1c97e1afa2e6a9d9eb","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/12516238","host_type":"repository"},{"url":"https://discovery.ucl.ac.uk/10216254/1/Real-World%20Comparison%20of%20High-Efficacy%20Versus%20Non-High-Efficacy%20Therapies%20in%20Multiple%20Sclerosis.pdf","host_type":"repository"},{"url":"https://pure.amsterdamumc.nl/ws/files/157477343/Real-world-comparison-of-high-efficacy-versus-non-high-efficacy-therapies-in-multiple-sclerosis.pdf","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC12516238","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC12516238?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["Multiple Sclerosis Research Studies","Peripheral Neuropathies and Disorders","vaccines and immunoinformatics approaches","Humans","Female","Male","Adult","Multiple Sclerosis, Relapsing-Remitting","Prospective Studies","Glatiramer Acetate","Middle Aged","Fingolimod Hydrochloride","Natalizumab","Dimethyl Fumarate","Longitudinal Studies","Immunologic Factors","Antibodies, Monoclonal, Humanized","Propensity Score","Treatment Outcome"],"mesh_terms":["Glatiramer Acetate","Fingolimod Hydrochloride","Natalizumab","Dimethyl Fumarate","Adult","Female","Humans","Immunologic Factors","Longitudinal Studies","Male","Middle Aged","Prospective Studies","Treatment Outcome","Multiple Sclerosis, Relapsing-Remitting","Propensity Score","Antibodies, Monoclonal, Humanized"],"keywords":["Medicine","Fingolimod","Natalizumab","Multiple sclerosis","Propensity score matching","Glatiramer acetate","Internal medicine","Relapsing remitting","Ocrelizumab","Dimethyl fumarate","McDonald criteria","Observational study","Logistic regression","Immunology","Rituximab","High Efficacy Therapies","Real‐world Comparison"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[{"name":"nct"}],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-10T02:55:11.249984Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}