ABSTRACT Managing multiple sclerosis (MS) with a highly active disease course presents significant challenges, particularly regarding the timing of therapeutic escalation and the preservation of brain volume. We present a personalized management strategy for a 36‐year‐old male with relapsing‐remitting MS (RRMS) who experienced initial misdiagnosis, frequent relapses, and a transition to a highly active phenotype triggered by COVID‐19 infection. By comprehensively evaluating prognostic factors, including spinal cord involvement and incomplete recovery from relapses, we transitioned the patient from moderate‐efficacy therapies (Siponimod, dimethyl fumarate) to high‐efficacy therapy (HET) with Ofatumumab. This timely escalation resulted in the stabilization of the Expanded Disability Status Scale (EDSS), cessation of new inflammatory activity, and a Brain Volume (BV), suggesting the resolution of pseudo‐atrophy or neuroplasticity. This case underscores that early identification of high disease activity and rapid escalation to HET are critical for stabilizing long‐term disability and potentially preserving brain integrity in the Chinese clinical context.
Wang et al. (Mon,) studied this question.