MS Treatment De-Escalation

May people believe stronger MS medications are better despite the increased risks. But should you take them long term? Is it safe to "deescalate" to a more conservative approach to reduce the risk of side effects (especially infections with immunosuppressants). I review the scientific evidence and multiple observational studies.

De-escalation of Disease-Modifying Therapy for People with Multiple Sclerosis Due to Safety Considerations: Characterizing 1-Year Outcomes in 25 People Who Switched from Ocrelizumab to Diroximel Fumarate: https://pubmed.ncbi.nlm.nih.gov/38861...
Evolution of Disease Modifying Therapy Benefits and Risks: An Argument for De-escalation as a Treatment Paradigm for Patients With Multiple Sclerosis: https://pubmed.ncbi.nlm.nih.gov/35145...
Clinical Outcomes of Escalation vs Early Intensive Disease-Modifying Therapy in Patients With Multiple Sclerosis: https://jamanetwork.com/journals/jama...
Treatment Escalation vs Immediate Initiation of Highly Effective Treatment for Patients With Relapsing-Remitting Multiple Sclerosis: https://www.ncbi.nlm.nih.gov/pmc/arti...
De-escalating rituximab dose results in stability of clinical, radiological, and serum neurofilament levels in multiple sclerosis: https://pubmed.ncbi.nlm.nih.gov/32840...
Is It Time for Ocrelizumab Extended Interval Dosing in Relapsing Remitting MS? Evidence from An Italian Multicenter Experience During the COVID-19 Pandemic: https://pubmed.ncbi.nlm.nih.gov/36036...
Ocrelizumab B-cell repopulation-guided extended interval dosing versus standard dosing – similar clinical efficacy with decreased immunoglobulin M deficiency rates: https://www.clinicalkey.com/#!/conten...
Anti-CD20 monoclonal antibodies in multiple sclerosis: Rethinking the current treatment strategy: https://pubmed.ncbi.nlm.nih.gov/38599...
Bridging the Gap, De-Escalation of MS Disease Modifying Therapies: https://www.neurologylive.com/view/br...
Interferon beta 1b following natalizumab discontinuation: one year, randomized, prospective, pilot trial: https://bmcneurol.biomedcentral.com/a...


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Dr. Brandon Beaber is a board-certified neurologist with subspecialty training in multiple sclerosis and other immunological diseases of the nervous system. He is a partner in the Southern California Permanente Medical Group and practices in Downey, California (South Los Angeles). He has several publications on MS epidemiology and has participated in clinical trials for MS therapeutics. You can follow him on twitter @Brandon_Beaber where he regularly posts about MS news and research.

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he video material by Dr. Brandon Beaber is general educational material on health conditions and is not intended to be used by viewers to diagnose or treat any individual's medical condition. Specifically, this material is not a substitute for individualized diagnostic and treatment advice by a qualified medical/health practitioner, licensed in your jurisdiction, who has access to the relevant information available from diagnostic testing, medical interviews, and a physical examination. To the extent that Dr. Beaber endorses any lifestyle change, behavioral intervention, or supplements, the viewer should consult with a qualified healthcare professional to determine the safety and efficacy of the intervention in light of their individualized information.