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Should we treat RRMS as early as possible?

Early medical intervention for the treatment of multiple sclerosis (MS) has been debated by experts for a number of years, with the likes of Gavin Giovannoni a Professor at Barts and the London School of Medicine and Dentistry and many others championing this course of action as a way of preventing irreversible disability.

Results from different randomised clinical trials support the early treatment of MS, but to date no real-life data have been provided to support the very long-term impact of such a treatment strategy.

As a result Dr Pietro Iaffaldano, Assistant Professor of Neurology University of Bari Aldo Moro, in Italy launched a pilot study using data pooled from five different MS registries. The Big MS Data (BMSD) Network evaluated the impact of the start time to disease modifying drugs (DMD) on the accumulation of long term disability in relapsing remitting MS (RRMS) patients.

A cohort of first-line DMD-treated (Interferon-beta, Glatiramer Acetate, Azathioprine) RRMS patients, with a minimum follow-up of 10 years, a minimum cumulative DMDs exposure of three years and at least 3 Expanded Disability Status Scale (EDSS) score evaluations was selected from the pooled cohort of the BMSD Network.

A cohort of 12,286 RRMS patients (female 8,625 (70.4%)) was retrieved. The median follow-up was 13.6 years, the median time to the first DMD start was 4.4 years, and the median DMD exposure was 9.2 years.

The 1st quintile of time to DMD start included patients treated within one year after the disease onset. During the follow-up an irreversible EDSS score of 4.0 and 6.0 was reached by 3,677 (34.6%) and 2,193 (18.3%) patients, respectively. The multivariate models for the risk of attaining EDSS 4.0 and EDSS 6.0 both revealed a significant association with the time to first DMD start. Patients belonging to the 2nd, 3rd, 4th and 5th quintile of the time from disease onset to the first DMD start were all at higher risk for developing irreversible disability in comparison to patients belonging to the 1st quintile.

Dr Iaffaldano concluded that the real-world data from the BMSD network confirms the effectiveness of an early treatment strategy in delaying the accumulation of irreversible disability in RRMS patients.

This study was announced at the ECTRIMS 2017 conference in Paris, France

Source: MS-UK

Date: 29/11/17

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