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Early versus later treatment start in multiple sclerosis: a register-based cohort study.

T A Chalmer1,2, L M Baggesen3, M Nørgaard3

  • 1Department of Neurology, Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen.

European Journal of Neurology
|May 31, 2018
PubMed
Summary

Starting disease-modifying therapy (DMT) for multiple sclerosis (MS) earlier is linked to better long-term outcomes. Early DMT initiation significantly reduces the risk of disability progression and shows a trend toward lower mortality compared to later treatment.

Keywords:
cohort studyepidemiologyimmunomodulating therapymultiple sclerosissex difference

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Area of Science:

  • Neurology
  • Clinical Research
  • Public Health

Background:

  • Multiple sclerosis (MS) is a chronic neurological disease.
  • Disease-modifying therapies (DMTs) are crucial for managing MS.
  • The optimal timing for initiating DMT remains a key clinical question.

Purpose of the Study:

  • To evaluate the long-term effectiveness of early versus delayed initiation of disease-modifying therapy (DMT) in multiple sclerosis (MS).
  • To compare disability progression and mortality rates between early and late DMT treatment groups.

Main Methods:

  • Utilized nationwide Danish MS registries for population-based data.
  • Categorized 3795 MS patients into early (<2 years from onset) and late (2-8 years from onset) treatment groups.
  • Employed Cox proportional hazards models with inverse probability of treatment weighting to analyze time to EDSS score of 6 and mortality.

Main Results:

  • Later DMT initiation was associated with a 42% increased hazard of reaching an Expanded Disability Status Scale (EDSS) score of 6.
  • This increased hazard was particularly pronounced in women.
  • A trend towards increased mortality was observed in the later-treated group, though not statistically significant.

Conclusions:

  • Starting DMT earlier in the course of multiple sclerosis is associated with significantly slower disability progression.
  • Delayed treatment initiation may lead to worse long-term outcomes, supporting earlier therapeutic interventions.
  • Evidence supports the clinical recommendation for early DMT initiation in MS management.