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

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.