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A retrospective cohort study examined 530 treatment-naive children with relapsing-remitting pediatric-onset multiple sclerosis (POMS) who received either high-efficacy treatment (HET) or moderate-efficacy treatment (MET) before adulthood. Both treatments reduced the risk of first relapse within the first 2 years, but HET showed a sustained 54% reduction in relapse risk over 5 years, with better tolerability and lower discontinuation rates compared to MET. These findings advocate prioritizing initial HET in POMS.
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