Early intensive therapy versus escalation strategy in French Caribbean multiple sclerosis cohort

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BACKGROUND: Data on Escalation Therapy versus Early Intensive Therapy (EIT) Strategy in multiple sclerosis (MS) are lacking, particularly in Afro-Caribbean cases, known for their severity. OBJECTIVES: To assess efficacy and safety of these strategies in a predominantly Afro-Caribbean relapsing-remitting MS population. METHODS: A multicenter retrospective study of 195 MS patients, including 66 on EIT, with ≥2 years follow-up. PRIMARY OUTCOME: Kaplan-Meier curves and log-rank test were used to assess irreversible progression to EDSS scores of 3, 6, and 8. SECONDARY OUTCOMES: change in EDSS score, risk factors for EDSS progression, and severe adverse effects. RESULTS: EIT showed slower EDSS 3 progression than Escalation (median survival 13.5 vs. 9.8 years, p = 0.024). After a median follow-up of 8 years, 89.5% on EIT remained free from EDSS 3 versus 63.8% on Escalation. Univariate analysis linked Escalation (hazard ratio (HR; 95% CI): 2.42 [1.09-5.34]), age at first relapse (HR: 1.04 [1.01-1.06]), incomplete symptom regression (HR: 1.69 [1.02-2.77]), and EDSS 3 progression. EDSS stabilized or decreased with EIT but worsened with Escalation (p < 0.001). Safety profiles were similar. CONCLUSIONS: EIT extends median time to irreversible EDSS 3 in Afro-Caribbean individuals compared to Escalation, supporting its preference as initial treatment.

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