Early intervention with high-efficacy disease-modifying therapy (HE DMT) may be the best strategy to delay irreversible neurological damage and progression of multiple sclerosis (MS). In European healthcare systems, however, patient access to HE DMTs in MS is often restricted to later stages of the disease due to restrictions in reimbursement despite broader regulatory labels. Although not every patient should be treated with HE DMTs at the initial stages of the disease, early and unrestricted access to HE DMTs with a positive benefit-risk profile and a reasonable value proposition will provide the freedom of choice for an appropriate treatment based on a shared decision between expert physicians and patients. This will further optimize outcomes and facilitate efficient resource allocation and sustainability in healthcare systems and society.

Department of Neurology 1st Medical Faculty Charles University Prague Czech Republic

Klinikum Klagenfurt Klagenfurt am Wörthersee Austria

Medical University Vienna Vienna Austria

MS Centre of Catalonia at the Hospital Vall d'Hebron Barcelona Spain

Neurology Unit Neurorehabilitation Unit Neurophysiology Service and Neuroimaging Research Unit Division of Neuroscience IRCCS San Raffaele Scientific Institute Via Olgettina 60 20132 Milan Italy

Ruhr Universität Bochum Bochum Germany

The Newcastle Upon Tyne Hospitals Newcastle upon Tyne UK

Università Degli Studi Di Napoli 'Federico II' Naples Italy

University of Bari Bari Italy

University of Basel Basel Switzerland

University of Padua Padua Italy

University of Pisa Pisa Italy

Vita Salute San Raffaele University Milan Italy

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