{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:53:34Z","timestamp":1782435214150,"version":"3.54.5"},"reference-count":34,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000381","name":"Multiple Sclerosis Society","doi-asserted-by":"publisher","award":["Grant Code 92"],"award-info":[{"award-number":["Grant Code 92"]}],"id":[{"id":"10.13039\/501100000381","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["RP\u20102017\u201008\u2010ST\u2010004"],"award-info":[{"award-number":["RP\u20102017\u201008\u2010ST\u2010004"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2025,10]]},"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\u2010efficacy DMTs should be the first choice remains debated. We compared treatment outcomes (no evidence of disease activity [NEDA] and its components) between treatment\u2010na\u00efve relapsing\u2013remitting MS (RRMS) patients commencing high\u2010efficacy therapies (HET) and non\u2010high\u2010efficacy therapies (non\u2010HET), 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\u2010world, single\u2010centre, longitudinal cohorts: (1) Relapsing\u2013remitting 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\u2010na\u00efve patients and had at least 2\u2009years of follow\u2010up. 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\u2010HET. The probability of losing NEDA was 57% and 39% lower in the HET group at year 1 and 2 (HR\u2009=\u20090.43; 95% CI\u2009=\u20090.35, 0.52; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01 and HR\u2009=\u20090.61; 95% CI\u2009=\u20090.45, 0.84; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01, respectively). The probability of relapse in the HET group was 94% and 71% lower at year 1 and 2 (OR\u2009=\u20090.06; 95% CI\u2009=\u20090.01, 0.28; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01 and OR\u2009=\u20090.29; 95% CI\u2009=\u20090.10, 0.84; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.02, respectively). The EDSS in the HET group was 30% and 18% lower at year 1 and 2 (Coeff\u2009=\u2009\u22120.30; 95% CI\u2009=\u2009\u22120.42, \u22120.18; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01 and Coeff\u2009=\u2009\u22120.16; 95% CI\u2009=\u2009\u22120.34, 0.02; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.09, respectively). The probability of MRI activity in the HET group was 82% lower at year 1 (OR\u2009=\u20090.18; 95% CI\u2009=\u20090.04, 0.86; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>This study demonstrated that treatment\u2010na\u00efve RRMS patients should be considered for high\u2010efficacy therapies based on a greater suppression of disease activity at 2\u2009years.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.70130","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T02:14:28Z","timestamp":1752718468000},"page":"2077-2085","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Real\u2010World Comparison of High\u2010Efficacy Versus Non\u2010High\u2010Efficacy Therapies in Multiple 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Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5541-5818","authenticated-orcid":false,"given":"Alessia","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Queen Square MS Centre, Department of Neuroinflammation UCL Queen Square Institute of Neurology  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charmaine","family":"Yam","sequence":"additional","affiliation":[{"name":"Queen Square MS Centre, Department of Neuroinflammation UCL Queen Square Institute of Neurology  London UK"},{"name":"Cleveland Clinic London Neurosciences Institute  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weaam","family":"Hamed","sequence":"additional","affiliation":[{"name":"Queen Square MS Centre, Department of Neuroinflammation UCL Queen Square Institute of Neurology  London UK"},{"name":"National Hospital for Neurology and Neurosurgery  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suraya","family":"Mohamud","sequence":"additional","affiliation":[{"name":"Queen Square MS Centre, Department of Neuroinflammation UCL Queen Square Institute of Neurology  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan J.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Queen Square MS Centre, Department of Neuroinflammation UCL Queen Square Institute of Neurology  London UK"},{"name":"National Hospital for Neurology and Neurosurgery  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Barkhof","sequence":"additional","affiliation":[{"name":"Queen Square MS Centre, Department of Neuroinflammation UCL Queen Square Institute of Neurology  London UK"},{"name":"National Institute for Health and Care Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre  London UK"},{"name":"Centre for Medical 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