This study compared the efficacy and safety of early intensive therapy (EIT) versus escalation therapy (EST) in patients with relapsing-remitting multiple sclerosis (RRMS) using a systematic review and meta-analysis. PubMed, Embase, and Cochrane databases were searched through January 9, 2026. Six observational studies reported hazard ratio (HR) for time to 6-month confirmed disability progression (CDP), and four reported HR for time to relapses. Heterogeneity (I²) was 0% for 6-month CDP and 28.3% for relapses. Pooled estimates were calculated using a common effect model. EIT significantly reduced the risk of 6-month CDP compared with EST (HR 0.73, 95% CI 0.66–0.80) and also reduced relapse risk (HR 0.58, 95% CI 0.50–0.66). Because of the low heterogeneity and limited number of studies, subgroup or meta-regression analyses were not performed. Quantitative safety analyses were conducted for key outcomes including adverse events (AE), serious adverse events (SAE), progressive multifocal leukoencephalopathy (PML), and cancer. EIT was associated with a significantly higher risk of SAEs compared with EST. AE, PML, and cancer did not show statistically significant differences between the two groups. Overall, EIT showed consistent benefits in reducing disability progression and relapse risk, and this study highlights the value of HR-based efficacy evaluation and quantitative synthesis of safety outcomes.