The landscape of multiple sclerosis treatment has substantially evolved over the past few years following the approval and commercialisation of several new drugs. Based on the mechanisms of action and efficacy and safety profiles of these drugs, for most patients one of two treatment approaches is normally used. The first approach, which focuses on safety, is escalation, and starts with lower risk disease-modifying therapies shifting to higher risk treatment if disease activity occurs. The second approach, which prioritises efficacy, is induction, in which a strong immune intervention is used from diagnosis of disease. Although consensus guidelines have been proposed to help neurologists in treatment decision making (not only how and when to start, but also the timing and type of switching), ^,  no universal approach exists.

中文翻译：

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重新思考多发性硬化症的治疗策略。

在数种新药的批准和商业化之后的几年中，多发性硬化症治疗的格局已发生了实质性变化。基于这些药物的作用机理，功效和安全性，大多数患者通常使用两种治疗方法之一。第一种以安全性为重点的方法是逐步升级，并从发生疾病活动的低风险疾病改变疗法开始转移到高风险治疗。优先考虑功效的第二种方法是诱导，其中从疾病诊断中使用了强大的免疫干预措施。尽管已经提出了共识指南来帮助神经科医生进行治疗决策（不仅是如何开始，何时开始，而且还包括转换的时间和类型）^，  没有通用的方法。