Does initial high efficacy therapy in multiple sclerosis surpass escalation treatment strategy? A comparison of patients with relapsing-remitting multiple sclerosis in the Czech and Swedish national multiple sclerosis registries

•Direct initiation of moderate-high efficacy therapy seems beneficial.•Moderate-high efficacy therapy does not lead to treatment switch due to adverse events.•Treatment strategy between Sweden and the Czech Republic differ.•Early moderate-high efficacy therapy initiation might lead to confirmed disability improvement.