Navigating the MS Therapy Explosion: Strategies for Proactive Initiation and Smart Treatment Switching

At the Consortium of Multiple Sclerosis Centers 2026 Annual Meeting, Scott D. Newsome, MD, MSCS, FAAN, FANA, delivered a comprehensive overview of the evolving landscape of multiple sclerosis (MS) treatment, emphasizing that the explosion of therapeutic options necessitates a more strategic approach to early intervention and switching. Since the approval of the first disease-modifying therapy (DMT) for MS in 1993, the field has grown to include more than 30 options.^1,2

“That doesn’t mean that each of these treatments will keep our patients safe from relapses, but I will make the strong argument that even our legacy therapies can keep people stable,” Newsome said.¹

The central theme of the presentation was the imperative to treat MS early and aggressively. Newsome argued against the concept of benign MS, noting that long-term studies show that nearly all untreated patients eventually develop disability.^1,3

“I think what we’ve learned is that treating early is better than later,” Newsome said, stressing that while the definition of early can be interpreted differently, clinicians must act to avoid future regret. “We don’t want to look back and say, ‘Shoot, we should’ve done something differently.’”¹

Newsome supported this stance with data from the MSBase Cohort, which followed 1555 people with relapsing-remitting MS for at least 4 years. The study found that initiating a DMT within 5 years of disease onset significantly lowered the risk of converting to secondary progressive MS compared to remaining untreated.⁴ Furthermore, Newsome highlighted research by Kalincik et al showing that while consistent use of any therapy reduces worsening, the risk of worsening was notably lower for those on high-efficacy therapies (6%) compared with those on injectables (59%).⁵

A critical component of this strategy is managing patient expectations. Many patients discontinue treatment because they do not feel an immediate improvement, but Newsome clarified that DMTs are primarily preventative.

“Many patients stop their treatment because the expectations are not aligned with their clinician,” Newsome said. “I’ve seen this in clinics where the patient says, ‘I’m not better.’ Well, these treatments are not going to reverse time.” Instead, Newsome explained that the goal is to optimize neurological reserve and prevent future progression.

When a treatment switch is required, timing and efficacy are paramount. Newsome references findings by Harding et al suggesting that a traditional escalation strategy may be inferior to starting with higher-efficacy therapy immediately.⁶ He warned that “…what we don’t want is thinking about switching after someone has developed a disability. We don’t have treatments that can reverse time, so that’s very important.”

Newsome also emphasized that disability accumulation begins early in the MS continuum, which encompasses both relapsing and progressing biology from the start. Newer medications—particularly monoclonal antibodies—have shown superior efficacy compared to older active comparators.⁷ However, legacy therapies may still have a role in keeping certain patients stable.

Beyond clinical data, Newsome emphasized that treatment decisions must be a shared process between the clinician and patient, accounting for factors such as age, comorbidities, and reproductive status. He specifically noted the importance of vaccination timing.

However, systemic barriers often complicate these clinical goals. Issues such as insurance coverage, geographic distance from MS centers, and the use of outside infusion centers can delay the start of therapy. To navigate these complexities, Newsome urged attendees to “partner up with your pharmacy colleagues” to ensure better access and safety monitoring.

Finally, Newsome touched on the challenges of an aging MS population. Most clinical trials do not include patients over 55 years of age, leading to a lack of knowledge regarding how treatments perform as patients age. Some evidence suggests that DMT efficacy may decrease in older populations, making the discussion around deescalation or discontinuation increasingly relevant as the patient population matures.

Ultimately, the goal remains a consistent, sustained treatment plan to mitigate the magnitude of worsening over time.

REFERENCES

1. Newsome SD, Macaron G, Oh J. Era of Too Many Choices: Starting and Switching. Presented at: Consortium of Multiple Sclerosis Centers 2026 Annual Meeting. May 27, 2026. Charlotte, NC.

2. Disease-modifying therapies for the treatment of MS. Multiple Sclerosis Association of America. Updated August 29, 2024. Accessed May 27, 2026. https://mymsaa.org/publications/about-ms/therapies/

3. Matas E, Bau L, Romero-Pinel L, et al. Benign multiple sclerosis and long-term outcomes after 30 years. J Neurol. 2025;272(11):747. doi:10.1007/s00415-025-13402-8

4. Zanghi A, Copetti M, Avolio C, et al. Multiple sclerosis from onset to secondary progression: a 30-year Italian register study. J Neurol Neurosurg Psychiatry. 2025;96(11):e335958.

5. Kalincik T, Diouf I, Sharmin S, et al. Effect of disease-modifying therapy on disability in relapsing-remitting multiple sclerosis over 15 years. Neurology. 2021;96(5):e783-e797. doi:10.1212/WNL.0000000011242

6. Harding K, Williams O, Willis M, et al. Clinical outcomes of escalation vs early intensive disease-modifying therapy in patients with multiple sclerosis. JAMA Neurol. 2019;76(5):536-541. doi:10.1001/jamaneurol.2018.4905

7. Longbrake EE, Parks BJ, Cross AH. Monoclonal antibodies as disease modifying therapy in multiple sclerosis. Curr Neurol Neurosci Rep. 2014;13(11):390. doi:10.1007/s11910-013-0390-z