{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:04:43Z","timestamp":1781003083286,"version":"3.54.1"},"reference-count":30,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["MS-1610-37047"],"award-info":[{"award-number":["MS-1610-37047"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There is growing support for high-efficacy disease-modifying therapy (DMT) in multiple sclerosis (MS), but escalation (ESC) approaches remain common.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To describe decision-making in a pragmatic trial of early high-efficacy treatment (EHT) versus ESC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>DELIVER-MS is a multi-center, pragmatic, randomized controlled trial (RCT) with a parallel observational study (OBS), which enrolled treatment-na\u00efve people with RRMS in 31 UK\/US sites. Primary outcome was as follows: 36-month brain volume loss according to initial treatment approach (EHT vs. ESC). Stepwise multivariable logistic regression was used to predict participation in RCT versus OBS and choice of EHT versus ESC within the OBS cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In total, 816 people with MS were enrolled. Participants declined randomization due to preference for a particular DMT (85%), efficacy concerns (20%), and safety concerns (9%). RCT versus OBS participation was associated with lower relapse rate (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.043) and greater brain parenchymal fraction (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.002). Among 374 in the OBS cohort, 125 (33%) chose ESC and 249 (67%) chose EHT. People commencing EHT had higher education attainment (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and relapse rate (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.025).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Baseline DELIVER-MS data demonstrate that participants with milder disease are more likely to participate in RCT. The choice of EHT versus ESC was associated with demographic factors and disease activity.<\/jats:p>\n                    <jats:p>Clinical trial registration: NCT03535298<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585261449988","type":"journal-article","created":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T07:56:04Z","timestamp":1780214164000},"page":"722-736","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Disease-modifying treatment preferences and decision-making in a multiple sclerosis randomized and observational clinical trial (DELIVER-MS)"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3760-6634","authenticated-orcid":false,"given":"Emma C","family":"Tallantyre","sequence":"first","affiliation":[{"name":"Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Department of Neurology, University Hospital of Wales, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5093-0754","authenticated-orcid":false,"given":"Sarah M","family":"Planchon","sequence":"additional","affiliation":[{"name":"Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet","family":"Howard","sequence":"additional","affiliation":[{"name":"Research and Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Mays","sequence":"additional","affiliation":[{"name":"Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Frowd","sequence":"additional","affiliation":[{"name":"Research and Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9245-9772","authenticated-orcid":false,"given":"Jeffrey A","family":"Cohen","sequence":"additional","affiliation":[{"name":"Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alasdair","family":"Coles","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5716-5645","authenticated-orcid":false,"given":"Carrie M","family":"Hersh","sequence":"additional","affiliation":[{"name":"Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8026-1854","authenticated-orcid":false,"given":"Deborah M","family":"Miller","sequence":"additional","affiliation":[{"name":"Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Dever","sequence":"additional","affiliation":[{"name":"Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma H","family":"Gray","sequence":"additional","affiliation":[{"name":"MS Society, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas G","family":"LaRocca","sequence":"additional","affiliation":[{"name":"National MS Society, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7833-8138","authenticated-orcid":false,"given":"Kunio","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Bale","sequence":"additional","affiliation":[{"name":"Person with MS, Nottingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwen","family":"Covey-Crump","sequence":"additional","affiliation":[{"name":"Veterinary Studies, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarunya","family":"Arun","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, University of Warwick, Coventry, UK; Neurology Clinical Reference Group, NHSE, London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wallace J","family":"Brownlee","sequence":"additional","affiliation":[{"name":"Department of Neuroinflammation, UCL Institute of Neurology, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt","family":"Craner","sequence":"additional","affiliation":[{"name":"University of Oxford, Oxford, UK; Frimley Health Foundation Trust, Camberley"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leorah","family":"Freeman","sequence":"additional","affiliation":[{"name":"Dell Medical School, The University of Texas at Austin, Austin, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Frost","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5675-945X","authenticated-orcid":false,"given":"Myla D","family":"Goldman","sequence":"additional","affiliation":[{"name":"Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh K","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Neurology, UTHealth Houston, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6299-5582","authenticated-orcid":false,"given":"Katharine E","family":"Harding","sequence":"additional","affiliation":[{"name":"Department of Neurology, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2114-7920","authenticated-orcid":false,"given":"Jeremy","family":"Hobart","sequence":"additional","affiliation":[{"name":"Clinical Neurology Research Group, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George J","family":"Hutton","sequence":"additional","affiliation":[{"name":"Maxine Mesinger Multiple Sclerosis Comprehensive Care Center, Baylor College of Medicine, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan H","family":"Hyland","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Rochester, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5405-2445","authenticated-orcid":false,"given":"Seema","family":"Kalra","sequence":"additional","affiliation":[{"name":"University Hospital North Staffordshire NHS Trust, Stoke-on-Trent, UK; Neuroscience and Neurology Group, School of Medicine, Keele University, Keele, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meena","family":"Kannan","sequence":"additional","affiliation":[{"name":"Atlanta Neuroscience Institute, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orhun","family":"Kantarci","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic Rochester, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lashley","sequence":"additional","affiliation":[{"name":"Clinical Neurology Research Group, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Lily","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don","family":"Mahad","sequence":"additional","affiliation":[{"name":"Centre for Neurodegeneration, The University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline A","family":"Nicholas","sequence":"additional","affiliation":[{"name":"OhioHealth Multiple Sclerosis Center, Columbus, OH, USA; 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