Spelman T, Magyari M, Piehl F, et al. - In this cohort study comparing patients in the Danish and Swedish multiple sclerosis registries, an association was found between differences in treatment strategies for relapsing-remitting multiple sclerosis and disability outcomes at a national level. The use of more efficacious disease-modifying treatment (DMT) as initial treatment was superior to escalating treatment efficacy.

• Between 2013 and 2016, a total of 2,700 patients from the Swedish MS registry (1,867 women [69.2%]; mean [SD] age, 36.1 [9.5] years) and 2,161 patients from the Danish MS registry (1,472 women [68.1%]; mean [SD] age, 37.3 [9.4 years]) began their first DMT and were followed for a mean (SD) of 4.1 (1.5) years.

• In total, 1,994 Danish patients (92.3%) started a low to moderately effective DMT (teriflunomide, 907 [42.0%]) and 165 (7.6%) started a highly effective DMT, while 1,769 Swedish patients (65.5%) started a low to moderately effective DMT (teriflunomide, 64 [2.4%]) and 931 (34.5%) started a highly effective DMT.

• In comparison to the Danish treatment strategy, the Swedish treatment strategy was linked to a 29% lower rate of postbaseline 24-week confirmed disability worsening.

• In comparison to Danish patients, the Swedish treatment strategy was also related to a 24% decline in the rate of achieving an expanded disability status scale score of 3 and a 25% decline in the rate of reaching an expanded disability status scale score of 4.