Project Summary

PCORI has identified multiple sclerosis (MS) as an important research topic. Patients, clinicians, and others want to learn how different treatment strategies, aimed at changing specific symptoms or the overall course of MS, affect patients’ symptoms and quality of life. To address this issue, PCORI launched an initiative in 2015 on Treatment of Multiple Sclerosis. The initiative funded this research project and others.

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

MS is long-term health problem that affects more than 2.5 million people worldwide. It is a leading cause of disability among young adults in North America. Relapsing-remitting MS, or RRMS, is the most common type of MS. People with RRMS experience periods of worsening symptoms, called relapses, followed by periods of few or no symptoms, called remission.

There are two approaches for treating RMMS. With the first approach, called escalation, treatment starts with a medicine regarded as safe but that may not prevent all relapses or new brain lesions. If relapses or new lesions occur, clinicians prescribe stronger medicines that are better at preventing lesions and relapses, but which have a small chance of serious side effects such as infections. With the second approach, early treatment with highly effective medicine, treatment starts with one of the strong medicines.

This study is comparing the benefits and risks of starting treatment with an escalation approach versus an early highly effective treatment approach for patients with RMMS.

Who can this research help?

Patients with RMMS and their doctors can use findings from the study when considering a treatment approach.

What is the research team doing?

The team is working with treatment centers in the United States and the United Kingdom to recruit 800 patients with RMMS who have not yet had treatment for the disease. The team is assigning patients by chance to receive either escalation treatment or early highly effective treatment. Patients who want to be in the study but do not want treatment assigned by chance can decide on treatment with their clinicians.

For three years, the team is following up to find out how much patients’ brains shrink. The team also is studying patients’ thinking and memory, arm and leg movements, and eyesight. Patients are reporting their symptoms, quality of life, satisfaction with treatment, and side effects.

The team is comparing the two treatment approaches to understand how well each approach delays worsening of the disease. The team is also examining whether one approach is safer and easier for patients.

Research methods at a glance

Design Elements Description
Design Randomized controlled trial, observational study
Population People with RMMS in the United States and United Kingdom who have not received treatment
  • Escalation treatment
  • Early highly effective treatment

Primary: brain volume loss from baseline to 36 months

Secondary: brain volume loss from month 6 to month 36, patient reports of symptoms, quality of life, satisfaction with treatment, and side effects
Timeframe 3-year follow-up for primary outcome

Project Information

Daniel Ontaneda, MD
Nikolaos Evangelou, MD, DPhil
Cleveland Clinic Foundation
Determining the Effectiveness of Early Intensive versus Escalation Approaches for the Treatment of Relapsing-Remitting Multiple Sclerosis (DELIVER-MS)

Key Dates

September 2017
March 2028

Study Registration Information


Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 28, 2024