What do you consider when deciding to use a high-efficacy DMT as an initial treatment in multiple sclerosis?

I'd say the question is when would you "not" consider a high-efficacy DMT in MS. High-efficacy therapies (specifically, B-cell depleting therapies) have a good risk profile and are exceptionally effective in treating relapsing MS. Evidence would suggest that you get the largest "bang for your buck" when using this class of medicine early in the disease, rather than waiting until later after the disability has already accrued.

For a small subset of patients, lifestyle factors or personal preferen...