Treating MS Soon After Symptoms Appear Can Delay Relapses, Study Says

A long-term study underscores the potential benefits, especially in terms of relapses, of multiple sclerosis (MS) patients beginning treatment as soon as possible after symptoms appear — even before the disease is definitely diagnosed. “The 11-year long-term follow-up study from the randomized BENEFIT CIS trial” was published in the journal Neurology.

Researchers in Switzerland recruited 468 patients with very early signs of MS, such as difficulties with vision or balance, stiffness or muscle spasms, fatigue, pain, poor memory, and suggestive brain lesions seen on an MRI scan. Typically 85 percent of the people with these symptoms, called clinically isolated syndrome (CIS), will eventually be diagnosed with MS.

“Not much research has been done on how starting treatment this early affects the long-term course of the disease,” study author Ludwig Kappos, MD, of University Hospital Basel in Basel, and a member of the American Academy of Neurology, said in a news release. “Our study adds to the evidence supporting treatment at the earliest sign of the disease and indicates that early treatment has a long-lasting effect on disease activity.”

Patients were randomly divided into two groups. One group received regular doses of interferon beta-1b, a standard treatment for MS, while the other group received a placebo. Those in the placebo group who were soon afterward diagnosed with MS — or two years after the study’s start — were allowed switch to either interferon beta-1b or another drug. Over the following 11 years, the researchers assessed patient progression, including whether they had fully developed  MS.

Eleven years after the initial randomization, all patients were asked to complete a comprehensive reassessment. A total of 167 patients received early treatment with interferon beta-1b, and 111 received a placebo in the delayed treatment group.

Results revealed that patients in the early treatment arm were 33 percent less likely to be clinically diagnosed with multiple sclerosis, compared with patients in the delayed treatment group. Those given early treatment also had a longer time to first relapse compared with those in the delayed treatment group (1,888 days compared to 931 days). Early therapy also had a 19 percent lower annualized relapse rate compared to the delayed group (0.21 versus 0.26).

No differences between the two groups, however, were seen in tests that evaluated overall disability or in MRI scans measuring the damage caused by the disease.

“Overall, early treatment appears to have a benefit on relapses, especially early in the disease, but limited effects on other outcome measures, including outcomes reported by patients,” said Brian C. Healy, PhD, of Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, and a member of the American Academy of Neurology, who wrote an accompanying editorial.