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Stronger MS drugs reduce relapses but not disability — yet. A real-world European study of 509 newly diagnosed MS patients found that B-cell-depleting and high-efficacy therapies significantly cut relapse rates and brain lesions compared to oral treatments. But after two years, disability scores were virtually the same across all treatment groups, pointing to a major unmet need in tackling long-term disease progression.
A large real-world study has found that while stronger multiple sclerosis (MS) drugs do a better job of controlling relapses and MRI activity, they don't appear to offer a meaningful advantage over oral therapies when it comes to slowing disability progression — at least within the first two years of treatment.
The MultipleMS cohort study tracked 509 newly diagnosed, treatment-naïve MS patients across seven European countries. Patients on B-cell-depleting therapies (like rituximab or ocrelizumab) had significantly fewer relapses and greater reductions in brain lesion volume compared to those on oral platform drugs. High-efficacy therapies showed similar trends. Yet disability scores — measured on the standard 0–10 EDSS scale — were statistically similar across all groups at the two-year mark.
Experts say the findings expose a critical gap: current high-efficacy drugs are powerful against acute inflammation but may do little to address the chronic, smoldering neuroinflammation that drives long-term disability. Emerging therapies like Bruton tyrosine kinase (BTK) inhibitors and anti-CD40 ligand antibodies are being watched closely as potential solutions.
By the Numbers:
Why it matters: This study reinforces that reducing relapses and slowing disability are two distinct challenges in MS — and that the field still lacks therapies that effectively target progressive disease. Longer follow-up may reveal whether early treatment differences eventually translate into disability benefits.
