Beginning treatment early with disease-modifying therapies is the most effective approach to prevent multiple sclerosis (MS) progression in patients, a large-scale study suggests.
Data from the Danish study will be presented at the 2018 Annual Meeting of the American Academy of Neurology (AAN), taking place April 21-27 in Los Angeles. The oral presentation is titled “Early versus Later Treatment Start in Multiple Sclerosis – A Register Based Cohort Study.”
The timing of MS treatment has been perceived as a critical step to prevent the disease from worsening, as well as to extend survival.
In the study, a research team evaluated the long-term effects of early treatment with disease-modifying therapies compared with a later treatment start in a real-world setting. They analyzed the clinical data of 3,795 MS patients who were registered in two Danish nationwide population studies.
Participants were divided into two groups according to when they began treatment. Early treatment was defined as beginning within two years after the first MS symptom — this included 2,316 patients. The late treatment group included 1,479 patients who started therapy between two and eight years from disease onset.
Patients were followed for a median time period of 10 years, during which disability progression and mortality were assessed.
Disability was assessed based on the Expanded Disability Status Scale (EDSS) score — the higher the score, the higher the disability level. In the study, researchers assessed the time it took patients to reach an EDSS score of 6, indicative of moderate-to-severe physical disability, requiring intermittent or unilateral constant assistance to walk such as a cane, crutch, or brace.
Data showed that patients who began treatment later had a 28% increased probability of faster disease progression, taking less time to reach EDSS 6, compared with patients who started treatment early.
This risk was found to be more pronounced in women treated later, who had a 39% increased probability of reaching EDSS 6, whereas men showed an increased probability of 9%.
Treatment timing, whether it was early or later, was not found to significantly change the mortality rates in patients included in the study.
These findings suggest that MS patients who start disease-modifying therapies later are more likely to experience faster disease progression, compared with patients who begin treatment earlier. Still, a delay in treatment does not seem to affect mortality rates.
According to the researchers, their results “support the scheme of early treatment.”
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