A 38-year-old woman with multiple sclerosis (MS) has relapsing-remitting disease with 2 relapses in 2 years and active MRI lesions. According to current treatment algorithms, she qualifies for which category of disease-modifying therapy (DMT)?

• A Platform therapy (interferon-beta, glatiramer acetate) — first-line only
• B Fingolimod first, then escalate only at 5 years
• C High-efficacy DMT (natalizumab, ocrelizumab, or alemtuzumab) ✓
• D No DMT — watchful waiting with symptomatic management

Explanation

Two or more relapses per year with active MRI lesions qualifies as highly active RRMS. Current MS society guidelines (AAN, EAN/ECTRIMS) recommend an 'early high-efficacy' or escalation approach — both strategies now accept natalizumab (anti-VLA-4), ocrelizumab (anti-CD20), or alemtuzumab as high-efficacy options. Multiple studies (OPERA I/II for ocrelizumab, AFFIRM for natalizumab) support superiority over platform therapies in active disease. Watchful waiting in active RRMS is not appropriate.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.