A 25-year-old woman has relapsing-remitting MS with two relapses in the past year, new enhancing lesions on MRI. She wants highly effective therapy. Per McDonald 2017 criteria and EAN/ECTRIMS guidelines, which disease-modifying therapy (DMT) is classified as high-efficacy first-line?
- A Interferon beta-1a (IFN-β1a)
- B Natalizumab or ocrelizumab ✓
- C Glatiramer acetate
- D Dimethyl fumarate
Explanation
Natalizumab (anti-VLA-4 integrin monoclonal antibody) and ocrelizumab (anti-CD20 monoclonal antibody) are classified as high-efficacy DMTs with 60–70% relative reduction in annualized relapse rates versus placebo, and are appropriate for highly active RRMS (defined as 2+ relapses in 1 year or new enhancing lesions on therapy). Ocrelizumab is also the only approved therapy for primary progressive MS (ORATORIO trial). IFN-β, glatiramer acetate, and DMF are moderate-efficacy first-line agents. An induction/escalation strategy beginning with high-efficacy therapy is increasingly recommended for active disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.