Italian MS Experts Reach Consensus on Early High-Efficacy Treatment Strategies

This landmark Italian Delphi consensus study represents a paradigm shift in multiple sclerosis treatment, moving away from the traditional escalation approach toward early, aggressive intervention. Sixty-five MS specialists from 54 major Italian centers participated in a rigorous two-round consensus process to establish evidence-based recommendations for high-efficacy disease-modifying therapy (HE-DMT) use.

The study addressed a critical gap in MS care: while HE-DMTs consistently outperform moderate-efficacy treatments in reducing relapses and disability progression, they're often reserved for patients who fail initial therapies. This delay can compromise long-term outcomes as MS pathology begins early, even before symptoms appear.

Experts achieved remarkable alignment, reaching strong consensus (≥80% agreement) on 33 of 43 statements and moderate consensus on 6 additional statements. Key agreements included unanimous support (100%) for early intervention to prevent irreversible disability and mandatory HE-DMT use in patients with aggressive disease features. The panel endorsed a comprehensive definition of high efficacy requiring substantial reductions in both inflammatory markers (>45-50% decrease in relapse rates, ≥80% reduction in MRI activity) and progression measures.

Crucially, the consensus identified specific clinical indicators warranting immediate HE-DMT initiation: MRI activity showing new lesions, neurodegeneration markers like neurofilament light chain elevation, and suboptimal clinical response to initial treatment. The experts emphasized personalized treatment decisions considering patient comorbidities, preferences, and family planning.

These findings challenge current practice patterns and may influence national healthcare policies, potentially improving access to optimal MS care across Italy's healthcare system.