First MS Disease-Modifying Therapy Approved
In 1993, interferon beta-1b became the first drug proven to alter MS's natural course, reducing relapses in relapsing-remitting MS by about 30%. This was revolutionary after a century of MS being untreatable. By 2010, several more disease-modifying therapies emerged (glatiramer acetate, natalizumab, fingolimod), but all followed an escalation approach: start with moderate drugs, switch to high-efficacy therapies only after disease worsens.
MS transformed from progressive disability sentence to manageable chronic condition for many patients; neurologists gained treatment options beyond symptom management.
The escalation paradigm became entrenched despite evidence that early aggressive treatment prevents irreversible damage better than waiting for progression.
For 30+ years, MS treatment has been one-size-fits-all escalation. The AI subtyping breakthrough challenges this orthodoxy by enabling personalized treatment from day one—early sNfL patients get high-efficacy drugs immediately, potentially preventing damage the escalation approach allows to accumulate.