A 28-year-old woman with relapsing-remitting MS has had two clinical relapses in the past year plus one new T2 lesion on MRI. She wants the most effective disease-modifying therapy. Which agent is classified as a high-efficacy therapy with evidence of superior relapse rate reduction compared to injectable therapies?

• A Natalizumab or ocrelizumab ✓
• B Interferon beta-1a
• C Glatiramer acetate
• D Teriflunomide

Explanation

Natalizumab (anti-VLA-4 integrin, AFFIRM trial) and ocrelizumab (anti-CD20, OPERA I and II trials) are classified as high-efficacy DMTs for RRMS, reducing annual relapse rate by 60–70% and 46–47% respectively compared to placebo/interferon. They are superior to first-line injectable therapies (interferons, glatiramer acetate) and teriflunomide, which achieve 29–34% relapse reduction. Current treat-to-target guidelines favour early high-efficacy therapy in patients with high disease activity.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.