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Early intervention with immunomodulatory agents in the treatment of multiple sclerosis
1Department of Neurology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. djeffery@wfubmc.edu
Abstract:
Multiple sclerosis (MS) is a lifelong neurologic disease leading to moderate or severe disability in the majority of affected patients. Studies of the natural history of MS suggest that 90% of patients with relapsing-remitting MS eventually develop secondary progressive (SP) disease. Magnetic resonance imaging (MRI) studies have consistently shown a high frequency of new T2 lesions and new gadolinium enhancing lesions even in the absence of clinical relapse. Lesion burden on T2 MRI increases by 5% to 10% per year and both axonal transection and cerebral atrophy are present at the earliest stages of RR MS. A wealth of evidence suggests that MS is a disease process that is continuously active, and that irreversible damage occurs early in the disease. Despite knowledge of the natural history and the availability of treatments that reduce relapse rates, decrease the accumulation of disability, and decrease surrogate measures of disease activity, only 60% of eligible patients have been treated with immunomodulating agents. This paper reviews the available evidence suggesting that immunomodulatory therapy modifies the natural history of MS and presents an argument for early intervention in the treatment of MS.
Insights
Early treatment with immunomodulatory agents can alter the course of multiple sclerosis (MS). Prompt intervention is crucial as irreversible neurological damage occurs early in MS, even before clinical symptoms appear.
Area of Science:
- Neurology
- Immunology
Background:
- Multiple sclerosis (MS) is a chronic neurological condition causing significant disability.
- Relapsing-remitting MS (RRMS) often progresses to secondary progressive MS (SPMS) in 90% of patients.
- MS is characterized by continuous disease activity, including new lesions and atrophy, even without clinical relapses.
Purpose of the Study:
- To review evidence on how immunomodulatory therapy affects the natural history of MS.
- To advocate for early intervention in MS treatment.
Main Methods:
- Review of existing scientific literature and magnetic resonance imaging (MRI) studies.
- Analysis of data on disease progression, lesion burden, and treatment efficacy.
Main Results:
- MS exhibits continuous activity with early irreversible damage, including axonal transection and cerebral atrophy.
- Despite available treatments, only 60% of eligible patients receive immunomodulatory agents.
- Immunomodulatory therapies have demonstrated efficacy in reducing relapses and disease activity measures.
Conclusions:
- Early immunomodulatory treatment can modify the natural history of MS.
- There is a strong rationale for initiating immunomodulatory therapy at the earliest stages of MS.
- Timely intervention is critical to mitigate long-term disability in MS patients.