Science
Host: Prof. Hans Peter Hartung In the management of multiple sclerosis there are essentially two therapeutic approaches. The first is a high-efficacy treatment typically reserved for patients with severe disease and a high number of relapses; the second is a slowly intensifying approach known as escalation in which less efficacious treatments are assessed before escalating to a second or third drug. High efficacy treatment comes with a higher risk/reward ratio than does escalation; but escalation can allow disease processes to continue beyond the window of opportunity for highest therapeutic benefit. How can clinicians make the correct choice for their patients?