ReviewJournal of personalized medicine2022
Escalation vs. Early Intense Therapy in Multiple Sclerosis.
Review in Journal of personalized medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- Safety and efficacy of oral cladribine in relapsing multiple sclerosis: a systematic review and meta-analysis.BMC neurology · 2025Pooled it
- A longitudinal analysis of real world symptom tracking and patient-reported outcomes in Brisa, a German Digital Health App for multiple sclerosis.PLOS digital health · 2026Article
- Aging with multiple sclerosis and associated prevalence, incidence, comorbidities and healthcare utilization patterns in a population based study.Scientific reports · 2026Article
- Antigen-Specific Inverse Vaccination Strategies Using Particle Systems for Multiple Sclerosis.ACS biomaterials science & engineering · 2026Review
- SMART-MC: Characterizing the Dynamics of Multiple Sclerosis Therapy Transitions Using a Covariate-Based Markov Model.Journal of the American Statistical Association · 2026Article
- Can We Improve Our Routine Urological Assessment to Exclude Neurogenic Causes for Lower Urinary Tract Dysfunction? ICI-RS 2024.Neurourology and urodynamics · 2025Review
- Humoral and Cellular Immunity After Vaccination Against SARS-CoV-2 in Relapsing-Remitting Multiple Sclerosis Patients Treated with Interferon Beta and Dimethyl Fumarate.Biomedicines · 2025Article
- Twenty years of natalizumab in multiple sclerosis: lessons learned and future outlook.Therapeutic advances in neurological disorders · 2025Review
- Shifts in treatment initiation patterns among newly diagnosed multiple sclerosis patients in Germany: a claims data analysis from 2017 to 2022.Therapeutic advances in neurological disorders · 2025Article
- Experience of using anti-CD 20 therapies in multiple sclerosis patients in Kenya.Frontiers in neurology · 2025Article
- PANORAMA: A 2021 Clinician Survey of Treatment Approaches for People With New Diagnoses of Relapsing-Remitting Multiple Sclerosis in the United Kingdom.International journal of MS care · 2025Article
- Holistic, Long-Term Management of People with Relapsing Multiple Sclerosis with Cladribine Tablets: Expert Opinion from France.Neurology and therapy · 2024Review
- Escalating to medium- versus high-efficacy disease modifying therapy after low-efficacy treatment in relapsing remitting multiple sclerosis.Brain and behavior · 2024Article
- Treatment algorithms of relapsing multiple sclerosis: an exploration based on the available disease-modifying therapies in China.Therapeutic advances in neurological disorders · 2024Review
- Treatment switches of disease-modifying therapies in people with multiple sclerosis: long-term experience from the German MS Registry.Therapeutic advances in neurological disorders · 2024Article
- Shifting from the treat-to-target to the early highly effective treatment approach in patients with multiple sclerosis - real-world evidence from Germany.Therapeutic advances in neurological disorders · 2024Article
- Article
- The Place of Immune Reconstitution Therapy in the Management of Relapsing Multiple Sclerosis in France: An Expert Consensus.Neurology and therapy · 2023Review
- Practical Guidance on the Use of Cladribine Tablets in the Management or Relapsing Multiple Sclerosis: Expert Opinion from Qatar.Degenerative neurological and neuromuscular disease · 2023Review
- The value of Interferon β in multiple sclerosis and novel opportunities for its anti-viral activity: a narrative literature review.Frontiers in immunology · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The treatment strategy of multiple sclerosis (MS) is a highly controversial debate. Currently, there are up to 19 drugs approved. However, there is no clear evidence to guide fundamental decisions such as what treatment should be chosen in first place, when treatment failure or suboptimal response should be considered, or what treatment should be considered in these cases. The "escalation strategy" consists of starting treatment with drugs of low side-effect profile and low efficacy, and "escalating" to drugs of higher efficacy-with more potential side-effects-if necessary. This strategy has prevailed over the years. However, the evidence supporting this strategy is based on short-term studies, in hope that the benefits will stand in the long term. These studies usually do not consider the heterogeneity of the disease and the limited effect that relapses have on the long-term. On the other hand, "early intense therapy" strategy refers to starting treatment with drugs of higher efficacy from the beginning, despite having a less favorable side-effect profile. This approach takes advantage of the so-called "window of opportunity" in hope to maximize the clinical benefits in the long-term. At present, the debate remains open. In this review, we will critically review both strategies. We provide a summary of the current evidence for each strategy without aiming to reach a definite conclusion.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.