Injectable disease-modifying drugs, like interferon and glatiramer acetate, are considered the first-line therapy for relapsing-remitting MS. However, despite being on these drugs, many patients continue to experience relapses and disability progression.

To reduce relapses and progression of disability, neurologists may switch patients to drugs that are believed to be more effective, but that can have serious side effects for some patients. This treatment management is called escalation therapy.

Natalizumab and fingolimod are commonly used for escalation therapy, as they are thought to be more effective than the injectable first line drugs. Recently, Annals of Neurology reported the results from a study in 26 countries, using 792 patients from the online database MSBase.


The study aimed to compare the efficacy of switching to fingolimod or natalizumab in patients who did not respond to interferon or glatiramer acetate.

The results suggest that, in relapsing-remitting patients who still experience relapses while they are being treated with injectable disease-modifying therapies, switching to natalizumab is more effective than switching to fingolimod in reducing relapse rate and promoting reduction of disability.

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