EMBARGOED FOR RELEASE UNTIL 4 PM ET, September 09, 2026
Early MS treatments differ most in relapses and MRI lesions, not disability
EMBARGOED FOR RELEASE UNTIL 4:00 P.M. ET, WEDNESDAY, SEPTEMBER 9, 2026
Highlights:
- A study of 509 people newly diagnosed with MS found only small differences after two years, based on the first treatment they used.
- People taking B-cell treatments had fewer MS attacks and a small drop in MRI lesions compared with people taking oral platform treatments.
- After two years, researchers did not find differences between the treatment groups in disability scores or blood signs of nerve damage.
- The study does not prove that one treatment causes better outcomes than another; it only shows an association.
MINNEAPOLIS — For people recently diagnosed with
multiple sclerosis (MS), early treatment choices were associated with only slight
differences after two years, based on the first treatment they used, according
to a study published September 9, 2026, in Neurology® Open
Access, an official journal of the American Academy
of Neurology. The study found that B-cell–depleting therapies, which
are given through an infusion in a vein and lower the number of B cells, a type
of immune cell that can play a role in MS, were associated with lower relapse
rates and reduced MRI lesion volume compared with oral therapies. While some
treatments were associated with fewer relapses and MRI changes, researchers
found no differences in disability scores after two years. The study does not
prove that one treatment strategy causes better outcomes than another; it only
shows associations.
“People with MS and their doctors have more treatment
choices than ever before, but it is still hard to know which treatment to start
with,” said study author Fredrik Piehl, MD, PhD, of Karolinska Institutet in
Stockholm, Sweden. “The treatment groups already differed in important patient
characteristics, suggesting that doctors were to some extent selecting
treatments based on the individual patient. Even so, B-cell–depleting therapies
and other strong treatments were linked to fewer relapses and fewer MRI changes.
But after two years, we did not see clear differences in disability scores.”
The study involved 509 people with an average age of 33 who
were newly diagnosed with relapsing or progressive MS and had not previously
received disease-modifying therapy. Participants were followed for two years.
Participants were grouped by the first treatment they
started within six months of the start of the study: 17% received injectable
platform therapies; 30% received oral platform therapies; 16% received
high-efficacy therapies, or stronger MS treatments used when doctors want to
control disease activity more aggressively; 20% received B-cell–depleting
therapies; and 18% received no treatment.
B-cell–depleting therapies included rituximab and
ocrelizumab. High-efficacy therapies included fingolimod, cladribine,
natalizumab and alemtuzumab. Oral platform therapies included dimethyl fumarate
and teriflunomide. Injectable platform therapies included interferon-beta and
glatiramer acetate.
Researchers looked at relapse rate, change in MRI lesion
volume and blood levels of serum neurofilament light chain, a biomarker of
nerve cell injury. They also looked at another biomarker called serum glial
fibrillary acidic protein, change in disability scores and whether participants
remained on their initial therapy at two years.
The relapse rate was lowest among people taking
B-cell–depleting therapies, at 0.04 relapses per year on average, compared with
0.16 for people taking oral platform therapies.
After adjusting for factors such as age, sex and disease
duration, people taking B-cell–depleting therapies had a 62% lower relapse rate
than those taking oral platform therapies. They did not find an association
between high-efficacy therapies and relapse rate.
For MRI findings, B-cell–depleting therapies were associated
with a slight reduction in lesion volume, a measure of disease-related brain lesions,
compared with oral platform therapies. A similar
trend was observed with other high-efficacy therapies, but the difference was
not statistically significant.
People taking B-cell treatments were most likely to stay on
their first treatment. After two years, 94% of people in this group were still
taking it. This compared with 87% of people taking high-efficacy therapies, 72%
taking oral platform treatments, 63% who were not treated and 61% taking
injectable platform treatments.
However, researchers found no differences between treatment
groups in disability score changes at two years. They also found no differences
between treatment groups in serum neurofilament light chain levels at two
years.
“These findings may help doctors and people with MS talk
about what to expect from early treatment,” Piehl said. “No single treatment
will be the best choice for everyone, and patient characteristics need to be
considered when selecting therapy. Some treatments were linked to fewer attacks
and fewer MRI changes, and by following this group for several more years, we
will be able to determine whether differences emerge over the longer term.”
A limitation of the study was that people were not randomly
put into treatment groups, so the results may have been affected by which
treatment they chose.
The study was supported by the European Union, the Swedish
Research Council, the Region Stockholm, the Swedish Brain Fund, Erling Perssons
Foundation, Knut and Alice Wallenberg Foundation, the German Research
Foundation and the Clinical Mass Spectrometry Center Munich.
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