Background: Disease-modifying therapies (DMTs) have led to improved health and work productivity among people with multiple sclerosis (PwMS)., Objectives: To describe trajectories of recent DMT use and their association with sickness absence and/or disability pension (SADP) among PwMS in Sweden., Methods: A longitudinal register-based study was conducted among 1395 PwMS with treatment start in 2014/2015. While DMT use over 5 years was assessed using sequence analysis resulting in four clusters, a 7-year (Y -2 toY 4 ) trend of SADP was analyzed using zero-inflated negative binomial regression., Results: Four clusters of DMT use trajectories were identified: long-term non-high-efficacy (483, 34.6%), long-term high-efficacy (572, 41%), escalation (221, 15.8%), and discontinuation (119, 8.5%). Progressive MS and higher expanded disability status scale scores were associated with the escalation, long-term high-efficacy , or discontinuation clusters. PwMS in the long-term high-efficacy and escalation clusters had higher likelihood of being on SADP. However, PwMS initiating high-efficacy DMTs demonstrated steeper decline in SADP than others., Conclusion: Using sequence analysis, this study showed recent DMT use trajectories among PwMS where initiation of high-efficacy DMTs has become more common. The trend of SADP was stable and lower in those using non-high-efficacy DMTs and larger improvements were shown in those initiating high-efficacy DMTs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: F.S.T. is funded partly by unrestricted research grant from Biogen and Celgene/Bristol-Myers Squibb. A.M. is funded partly by unrestricted research grant from Biogen. K.F. received honoraria for serving on advisory boards for Biogen, Merck, and Roche and speaker’s fees from Merck. H.G. has previously been funded partly by unrestricted research grant from Biogen. At the time of conducting this study, H.G. was employed by IQVIA; a contract research organization that performs commissioned pharmacoepidemiological studies and therefore was collaborating with several pharmaceutical companies. J.H. received honoraria for serving on advisory boards for Biogen, Bristol-Myers-Squibb, Janssen, Merck KGaA, Novartis, Sandoz, and Sanofi-Genzyme and speaker’s fees from Biogen, Janssen, Novartis, Merck, Teva, Sandoz, and Sanofi-Genzyme. He has served as P.I. for projects sponsored by, or received unrestricted research support from, Biogen, Bristol-Myers-Squibb, Janssen, Merck KGaA, Novartis, Roche, and Sanofi-Genzyme. His MS research is funded by the Swedish Research Council and the Swedish Brain foundation. E.F. has previously been funded partly by an unrestricted research grant from Biogen, has received unrestricted research grants from Celgene/Bristol-Myers Squibb, and speaker’s fees from Merck.