A 28-year-old woman is diagnosed with relapsing-remitting multiple sclerosis after her second clinical attack and MRI showing dissemination in space and time. She requests the most effective disease-modifying therapy. Which agent has the highest efficacy in preventing relapses and disability progression in RRMS?

• A Interferon beta-1a (Avonex)
• B Glatiramer acetate
• C Teriflunomide
• D Alemtuzumab or cladribine (high-efficacy agents) ✓

Explanation

High-efficacy DMTs for RRMS include natalizumab (anti-VLA-4), ocrelizumab (anti-CD20), alemtuzumab (anti-CD52), and cladribine (oral, selective lymphocyte depletion). These achieve 50–70%+ reduction in annualised relapse rate and significant disability protection compared to platform therapies (IFN-beta, glatiramer acetate, teriflunomide) which achieve 30–40% reduction. Current guidelines advocate an 'early high-efficacy' approach in young patients with active disease, particularly those with poor prognostic features, to prevent irreversible disability accumulation.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.