{"id":2146,"date":"2026-06-04T01:26:00","date_gmt":"2026-06-04T01:26:00","guid":{"rendered":"https:\/\/wickedsister.evit.com.au\/index.php\/2026\/06\/04\/trial-of-esclation-verses-early-high-efficacy-treatmentlets-guess-what-will-happen\/"},"modified":"2026-06-04T01:26:00","modified_gmt":"2026-06-04T01:26:00","slug":"trial-of-esclation-verses-early-high-efficacy-treatmentlets-guess-what-will-happen","status":"publish","type":"post","link":"https:\/\/wickedsister.evit.com.au\/index.php\/2026\/06\/04\/trial-of-esclation-verses-early-high-efficacy-treatmentlets-guess-what-will-happen\/","title":{"rendered":"TRIAL OF ESCLATION VERSES EARLY HIGH-EFFICACY TREATMENT\u2026Let\u2019s guess what will happen"},"content":{"rendered":"
Tweet<\/a><\/div>\n

You will note there is no ProfK, ProfG, NDG etc on this one because they declined to participate because they were unwilling to randomise any MS-newbie onto a lower efficacy agent. This decision is vindicated by the findings that people randomised to lower efficacy agents did less well….I guess a bit of a “Duh” moment. BartsMS and Stoke have been leading the way in England with the use of high efficacy over lower efficacy drugs. There are some places that are still happy to use lower efficacy agents and thankfully their numbers have shrunk between 2019 and 2025 when I last looked. But there are still neurological lagards out there.<\/p>\n

Here people were allowed to enter trial to be randomised to low (Boooo) or high efficacy treatment or they could decline and make a choice. Over 30% selected low efficacy. Concerns over efficacy were higher in the United States versus United Kingdom (27% vs. 13%,\u00a0p<\/em>\u2009=\u20090.002), and safety concerns were more prominent in the United Kingdom versus United States (12% vs. 5.7%,\u00a0p<\/em>\u2009=\u20090.061)…..so is there medical gaslighting here<\/p>\n

Now we wait to see the impact<\/p>\n

Tallantyre EC, Planchon SM, Howard H, Mays J, Frowd N, Cohen JA, Coles A, Hersh CM, Miller DM, Dever M, Gray EH, LaRocca NG, Nakamura K, Bale C, Covey-Crump G, Alvarez E, Arun T, Brownlee WJ, Craner M, Freeman L, Frost N, Goldman MD, Gupta RK, Harding KE, Hobart J, Hutton GJ, Hyland MH, Kalra S, Kannan M, Kantarci O, Lashley D, Lily O, Mahad D, Nicholas JA, Nicholas R, Paling D, Pearson OR, Rice CM, Samudralwar R, Schmalstieg WF, Singh M, Zune The E, Weinstock-Guttman B, Zabeti A, Love TE, Gunzler DD, Liu Y, Gerry S, Evangelou N, Ontaneda D. Disease-modifying treatment preferences and decision-making in a multiple sclerosis randomized and observational clinical trial (DELIVER-MS). Mult Scler. 2026 May 31:13524585261449988. doi: 10.1177\/13524585261449988. Epub ahead of print. PMID: 42218617.<\/p>\n

Background: <\/strong>There is growing support for high-efficacy disease-modifying therapy (DMT) in multiple sclerosis (MS), but escalation (ESC) approaches remain common.<\/p>\n

Objective: <\/strong>To describe decision-making in a pragmatic trial of early high-efficacy treatment (EHT) versus ESC.<\/p>\n

Methods: <\/strong>DELIVER-MS is a multi-center, pragmatic, randomized controlled trial (RCT) with a parallel observational study (OBS), which enrolled treatment-na\u00efve people with RRMS in 31 UK\/US sites. Primary outcome was as follows: 36-month brain volume loss according to initial treatment approach (EHT vs. ESC)……<\/p>\n

Results: <\/strong>In total, 816 people with MS were enrolled. Participants declined randomization due to preference for a particular DMT (85%), efficacy concerns (20%), and safety concerns (9%). RCT versus OBS participation was associated with lower relapse rate (p<\/em> = 0.043) and greater brain parenchymal fraction (p<\/em> = 0.002). Among 374 in the OBS cohort, 125 (33%) chose ESC and 249 (67%) chose EHT. People commencing EHT had higher education attainment (p<\/em> < 0.001) and relapse rate (p<\/em> = 0.025).<\/p>\n

Conclusion: <\/strong>Baseline DELIVER-MS data demonstrate that participants with milder disease are more likely to participate in RCT. The choice of EHT versus ESC was associated with demographic factors and disease activity.<\/p>\n

Source: multiple-sclerosis-research.org<\/a><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Tweet You will note there is no ProfK, ProfG, NDG etc on this one because they declined to participate because they were unwilling to randomise any MS-newbie onto a lower efficacy agent. This decision is vindicated by the findings that people randomised to lower efficacy…<\/p>\n","protected":false},"author":0,"featured_media":0,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[11,15,9,8,13,14,12,10],"class_list":["post-2146","post","type-post","status-publish","format-standard","hentry","category-multiple-sclerosis-research","tag-brain-repair","tag-marburg-type-ms","tag-ms","tag-multiple-sclerosis","tag-myelin","tag-neuroregeneration","tag-oligodendrocyte","tag-remyelination"],"_links":{"self":[{"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/posts\/2146","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/comments?post=2146"}],"version-history":[{"count":0,"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/posts\/2146\/revisions"}],"wp:attachment":[{"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/media?parent=2146"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/categories?post=2146"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/tags?post=2146"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}