Treatment for MS within 6 months of the first demyelinating event improved EDSS scores, disability progression, and conversion to secondary progressive MS.
“Although it is clear that disease-modifying treatment in MS reduces disability in the long term, less is known about the impact of early treatment on long-term outcomes,” Alvaro Cobo-Calvo, MD, PhD, explains. “We wondered whether very early treatment—meaning within 6 months of the first demyelinating event—could have an impact on disability in the long term. In addition, we wanted to use information from MRIs of the brain to build predictive models of disability.”
For a study published in Neurology, Dr. Cobo-Calvo and colleagues examined the impact of very early treatment on the risk for long-term disability. The researchers included data from 580 patients with a first demyelinating event, obtained prospectively from 1994 to54 2021, who were treated with at least one disease-modifying agent. They grouped patients into tertiles based on the time from the first demyelinating event to treatment with a disease-modifying agent: first tertile, in which patients were treated within 6 months (n=194); second tertile, in which patients were treated within 6.1 to 16 months (n=192); and third tertile, in which patients were treated within 16.1 months (n=194).
Improvements in EDSS & Disease Progression
Very early treatment reduced the risk of reaching an EDSS score of 3.0 (HR, 0.55; 95% CI, 0.32-0.97), secondary progressive MS (HR, 0.40; 95% CI, 0.19-0.85), and sustained disease progression 12 months after starting treatment (HR, 0.50; 95% CI, 0.29-0.84) in comparison with the TT group.
“From a practical standpoint, it is important to stress that the diagnostic work-up must be performed quickly to be certain that first symptoms are compatible with MS and start treatment,” Dr. Cobo-Calvo says. “We found that, once the first symptoms are detected, the risk of reaching moderate disability (EDSS score of 3.0) decreases dramatically—by 45%—with earlier treatment. The faster you start treatment, the less disability the patient will develop.”
Further, earlier treatment decreased the risk for conversion to secondary progressive MS by 60% and the risk for disability progression at 1 year after treatment initiation by 53% (Table), according to Dr. Cobo-Calvo. He characterized these improvements as “quite spectacular.”
In their assessment of the role that MRI results have on treatment decisions, the researchers included a subgroup of treated patients for whom all radiological information was available. They found that a higher MRI score correlated with a shorter time to treatment initiation after the first demyelinating event. Specifically, there was a decrease of up to 62% between patients with the lowest and the highest MRI scores, according to the study results.
Directions for Future Research
The researchers conclude that this study is the first to assess the impact of very early MS treatment on future disability in a prospective manner.
The findings indicate “the highly important impact” that early treatment can have for patients with MS, Dr. Cobo-Calvo says. Further, they confirm the role for MRI in guiding treatment decisions by showing, “the strong association of baseline radiological information with time of treatment initiation.”
Dr. Cobo-Calvo notes, however, that the study did not analyze the effect of early treatment versus late treatment with high-efficacy drugs alone due to a small sample size. “This is important, because effectivity seem greater with highly effective drugs than with moderately effective drugs, and we need to know when to start treatment with these high-efficacy drugs.”
Further, the predictive models in the current study were developed with the introduction of baseline radiological data. “It would be interesting to introduce radiological information obtained over the whole disease course (eg, systematically every 1 or 2 years),” he says.
