Switching high efficacy therapies in Multiple Sclerosis: Does real world experience support such a strategy?

Multiple sclerosis (MS) is an immune-mediated inflammatory demyelinating and degenerative disease of the central nervous system characterized by clinical relapses and progressive disability. Therapeutic options have expanded greatly over the past three decades, resulting in the approval of several classes of disease-modifying therapies (DMTs) with distinct or overlapping mechanisms of action, clinical efficacy, and potential adverse effects. Because DMTs are partially effective in controlling disease activity, switching and appropriate sequencing of different drugs are paramount in the treatment decision process.