In the animules the severity of disease is graded and so we see this or that cure of the Week being offered from the beasties as we see a mega claim for benefit on essentially a marginal difference in score. I have long said you can’t have half a relapse it is a relapse or it is not a relapse. It perhaps supported by this current study that looks on the effect of disease modifying therapy on the severity of relapse. The data suggest that higher efficacy DMT do not do better than people on moderate efficacy but I had to say the jury needs to be out because this is an n=85 and needs to be n=85,000 maybe the MSBase can have a look. However it sort of says the way we assess MS is not that great if it is an all or nothing as you are more likely to dismiss things that are having some impact…Maybe if we took this attitude then most of the knockout and other EAE would be seen as being meaningless. I must admit that is the way I view many of the studies as there is limited translatable value and some of the claims that have shaped thoughts. You do not blame the animals for this, except the human animals who make the claims and those that buy the claims.
Disclaimer. My views
Rodriguez de Antonio LA, García-Castañón I, González-Suárez I, Oreja-Guevara C. Breaking the assumption: Disease-modifying therapy efficacy and relapse severity in relapsing-remitting multiple sclerosis. Mult Scler Relat Disord. 2025 Sep 4;104:106723.
Background: The severity of relapses is lower in patients treated with DMTs compared to untreated patients. Although Disease-modifying treatments (DMTs) differ considerably in their efficacy for relapse prevention, the specific impact of different DMTs on relapse severity has not yet been thoroughly investigated.
Objective: To study the relationship between DMT use, relapse severity and recovery outcomes in relapsing-remitting multiple sclerosis (RRMS).
Methods: A restrospective cohort study analyzed 85 RRMS patients treated with either moderate-efficacy DMTs (interferons, glatiramer acetate, teriflunomide, dimethyl fumarate; n = 48) or high-efficacy DMTs (fingolimod, natalizumab, ocrelizumab, alemtuzumab, cladribine; n = 37). Regular EDSS assessments were used to evaluate relapse severity and subsequent recovery.
Results: Although patients on high-efficacy DMTs tended to experience less severe relapses (ΔEDSS = 0.49 ± 0.59 vs 0.71 ± 0.68 with moderate-efficacy DMTs; p = 0.12), multivariable analysis did not confirm a significant influence of high-efficacy treatment on relapse severity (OR = 0.46; 95 % CI: 0.13-1.61; p = 0.22). Relapse recovery showed a similar gradual improvement in both groups, with a slightly lower increase in disability among patients on high-efficacy DMTs at 6 months (0.26 ± 0.89 vs 0.39 ± 0.73; p = 0.46) and 12 months (0.27 ± 0.83 vs 0.31 ± 0.78; p = 0.98), though without statistically significant differences. Baseline EDSS emerged as the main determinant of relapse severity (OR=0.40; 95 % CI: 0.21-0.77; p = 0.006).
Conclusions: These findings indicate that, among the DMTs analyzed (both moderate- and high-efficacy), the level of preventive efficacy does not substantially modify relapse severity or recovery once a relapse occurs.
Source: multiple-sclerosis-research.org