To evaluate if disease-modify therapy (DMT) choice has changed for treatment-naïve multiple sclerosis (MS) patients from 2020-2022.

US neurologists (2020: N=199; 2021: N=205; 2022: N=208) completed a survey and contributed chart reviews for a retrospective, cross-sectional audit on MS patients who started their first DMT within the prior 3 months (2020: N=1,006; 2021: N=1,018; 2022: N=1,095). MS patients were analysed as a whole, as well as by physician-reported MS subtypes for relapsing-remitting MS (RRMS; N=722, N=768, N=827), active secondary progressive MS (aSPMS; N=74, N=50, N=59), and primary progressive MS (PPMS; N=92, N=69, N=72).

Overall use of glatiramer acetate (GA) (32% in 2020, 16% in 2022) has declined; use of fumarate agents (13%, 21%) and anti-CD20 monoclonal antibody (mAb) DMTs (13%, 21%) expanded. Interferon (13% in 2020 and 2022) and S1P receptor modulator class (12%, 14%) use has remained stable.

Use of both brand (18%, 11%) and generics (14%, 6%) of GA declined. For fumarates, use has shifted from branded dimethyl fumarate (DMF; 13%, 8%) to generic DMF (0%, 6%) and diroximel fumarate (0%, 6%). For S1Ps, use has shifted from fingolimod (10%, 6%) to ozanimod (0%, 4%) and ponesimod (0%, 1%).

Changes in DMT use are similar for RRMS: GA use declined (31%, 16%); fumarates (17%, 23%) and anti-CD20 mAb DMT (9%, 19%) use expanded. GA use also declined for aSPMS (30%, 7%) and PPMS (30%, 8%); anti-CD20 mAb DMT use grew for aSPMS (19%, 41%).