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Early Intensive Versus Escalation Approach: Ten-Year Impact on Disability in Relapsing Multiple Sclerosis.

Pietro Iaffaldano1, Giuseppe Lucisano2, Tommaso Guerra1

  • 1Department of Translational Biomedicines and Neurosciences (DiBraiN), University of Bari "Aldo Moro", Bari, Italy.

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Summary

Early intensive treatment (EIT) with high-efficacy disease-modifying therapies (HE-DMTs) significantly slows disability progression in relapsing multiple sclerosis (RMS) compared to escalation strategies. This approach optimizes long-term outcomes for RMS patients.

Keywords:
PIRAdisability trajectoriesmultiple sclerosis

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Area of Science:

  • Neurology
  • Immunology
  • Clinical Research

Background:

  • Relapsing multiple sclerosis (RMS) is characterized by unpredictable neurological disability.
  • Treatment strategies aim to mitigate disease progression and maintain patient function.
  • High-efficacy disease-modifying therapies (HE-DMTs) represent advanced treatment options.

Purpose of the Study:

  • To compare the long-term impact of early intensive treatment (EIT) versus escalation (ESC) strategies using HE-DMTs on disability progression in RMS.
  • To assess the influence of treatment timing on disability trajectories and specific worsening events.

Main Methods:

  • Observational study of 4878 RMS patients from the Italian Multiple Sclerosis Register with ≥5 years follow-up.
  • Patients categorized into EIT (immediate HE-DMTs) or ESC (HE-DMTs after ≥1 year of moderate-efficacy therapy).
  • Propensity score matching used to balance baseline characteristics; outcomes analyzed using linear mixed models and Cox proportional hazards models.

Main Results:

  • EIT group showed significantly slower disability progression compared to ESC group over 10 years (delta-EDSS difference -0.63).
  • ESC was associated with increased risks of confirmed disability accrual (CDA), progression independent of relapse activity (PIRA), and relapse-associated worsening (RAW).

Conclusions:

  • Early intensive treatment (EIT) with HE-DMTs significantly reduces long-term disability progression in RMS.
  • Initiating HE-DMTs early may optimize long-term outcomes and reduce the risk of various disability worsening events in RMS patients.