First-line treatments for relapsing-remitting MS (RRMS) are often lower-risk DMTs like interferon-beta (IFN-beta, examples include Avonex), and Tecfidera (dimethyl fumarate). People generally switch to more highly active therapies, such as Gilenya and Tysabri (natalizumab), if disease activity persists. Lemtrada was shown in clinical trial to effectively reduce disease activity in treatment-naive patients and in those unresponsive to first-line DMTs. However, data regarding Lemtrada after other DMTs use can be both inconsistent and incomplete, complicating efforts to manage progression. “Real-world data on specific treatment sequences remains sparse and the optimisation of the escalating therapeutic management remains short of general consensus,” the researchers wrote.