Early MS Treatments Impact Relapses And Brain Scarring Differently, But Not Disability

FRIDAY, Oct. 16, 2026 (HealthDay News) — Therapy targeting the immune system’s B cells might offer better odds against relapses in the early stages of multiple sclerosis (MS), a new study reports.

People taking IV drugs that lower immune B-cell levels had a 62% lower rate of relapse than those taking pills frequently prescribed for early MS, the study team found.

The findings were published recently in the journal Neurology Open Access.

Patients were also less likely to develop brain scarring associated with MS if they started B-cell-depleting therapies slightly after their diagnosis, researchers said.

However, disability progressed about the same in all MS patients within two years of their diagnosis, regardless of the early treatment they were given, results show.

“People with MS and their doctors have more treatment choices than ever before, but it is still hard to know which treatment to start with,” said senior researcher Dr. Fredrik Piehl, a professor of neurology with Karolinska Institutet in Stockholm, Sweden.

“The treatment groups already differed in important patient characteristics, suggesting that doctors were to some extent selecting treatments based on the individual patient,” Piehl said in a news release. “Even so, B-cell–depleting therapies and other strong treatments were linked to fewer relapses and fewer MRI changes. But after two years, we did not see clear differences in disability scores.” 

There’s been a boom during the last two decades in medications that promise to help slow the progression of MS, but few studies have been done comparing how well they perform head-to-head.

To provide some clarity, the team tracked 509 people newly diagnosed with relapsing or progressive MS, based on one of four types of initial treatments they were given:

1. Injectable therapies (interferon-beta, glatiramer acetate)

2. Pills (dimethyl fumarate, teriflunomide)

3. High-efficacy therapies (fingolimod, cladribine, natalizumab, alemtuzumab)

4. B-cell-depleting therapies (rituximab, ocrelizumab)

Of those patients, 90 received no early treatment at all and were also included in the analysis. The average age of all patients was 33.

Results showed that the relapse rate was lowest among people taking B-cell-depleting therapies, around 0.04 relapses per year on average. By comparison, the relapse rate was 0.16 for people taking pills.

B-cell-depleting therapies were also linked to a slight reduction in disease-related brain scarring compared to pills.

The study team did not find a statistically significant result for high-efficacy therapies on either relapse rate or brain lesions in early treatment.

B cells act as the immune system’s memory, containing a list of antibodies that can counter infections the body has previously encountered. Scientists think that B cells might also stimulate the production of toxic substances that damage nerve cells, according to the MS Society in the U.K.

People taking B-cell treatments were also most likely to stay with this first line of therapy. After two years, 94% were still taking it, compared to 87% of people taking high-efficacy therapies, 72% taking pills, 63% who started out on no treatment and 61% of those receiving injectable medications.

But after following patients for two years, researchers found no differences in changes in disability scores. They also found no differences between treatment groups in blood markers of brain damage.

Piehl said this new information could help doctors and patients with MS discuss what to expect from treatment.

“No single treatment will be the best choice for everyone, and patient characteristics need to be considered when selecting therapy,” Piehl said. “Some treatments were linked to fewer attacks and fewer MRI changes, and by following this group for several more years, we will be able to determine whether differences emerge over the longer term.”

More information

Harvard Medical School has more on multiple sclerosis.

SOURCES: American Academy of Neurology, news release, Sept. 9, 2026; Neurology Open Access, Sept. 9, 2026