Abstract
The most commonly used treatment algorithm in multiple sclerosis (MS) is initiation with lower efficacy drugs, i.e. first-choice drugs, and, in case of their failure, escalation to drugs with higher efficacy, also known as HET (High Efficacy Treatment). The use of high-efficacy drugs at an early stage of the disease, however, appears to be a superior strategy in delaying progression and irreversible damage to the central nervous system.
The favourable safety profile of these drugs allows to aim, from the very beginning of MS treatment, at complete stabilization of clinical parameters and of the finding on magnetic resonance imaging. However, the complicated and confusing system of restrictive reimbursement criteria is an obstacle to using high-efficacy drugs freely.