DMT early is better than late but late is better than never

Cocco E, Sardu C, Spinicci G, Musu L, Massa R, Frau J, Lorefice L, Fenu G, Coghe G, Massole S, Maioli MA, Piras R, Melis M, Porcu G, Mamusa E, Carboni N, Contu P, Marrosu MG Influence of treatments in multiple sclerosis disability: A cohort study. Mult Scler. 2014 Sep. pii: 1352458514546788. [Epub ahead of print]

BACKGROUND AND OBJECTIVE: A critical aspect of multiple sclerosis (MS) treatments is understanding the effect of disease-modifying drugs (DMDs) on the long-term risk of disability and whether the effect is related to disability at start of treatment.
METHODS: We performed an observational study on 3060 MS patients. The effect of therapy on progression to Expanded Disability Status Scale (EDSS) 3.0 and 6.0 from onset was analysed in treated vs untreated (UTP) patients.

RESULTS: Compared to UTP, the risks of EDSS 3.0 were 94% and 73% lower in immunomodulant (IMTP-) and immunosuppressant (ISTP-) treated patients, respectively, while the risk of EDSS 6.0 was 86% lower in IMTP. The risk of EDSS 6.0 was, respectively, 91% and 75% lower in 1275 IMTP before and 114 after EDSS 3.0 than in 539 UTP; the risk was higher in IMTP starting therapy after EDSS 3.0 than before (HR = 4.42).
CONCLUSIONS:  DMDs delayed long-term disability in MS patients treated either in the early or, to a lesser extent, in the later phase of the disease. Thus, the window of therapeutic opportunity is relatively extended, assuming that early is better than late treatment, but late is better than never.

Give the Flack that Arie and MD2 have been taking from some of you, first I will say in terms of CoI that none are relevant but we have got grant money from some pharma who produce MS drugs. Start early and they will reap benefits but this study it can work for you too.

I think the conclusions are easy to read and the take home message is simple take a DMT and you do better than if you don't take a DMT. Take a DMT early and you appear to do better than starting later rather than sooner but that is better than doing nothing. As ever this is an observational study and so lacks the robustness of proper clinical trials with good  follow. Furthrmore it shows that we need to do better with DMT as disability continues in people who are treated. I suspect if we dispense with the low efficacy DMT and repeat this such again in a few years the the outcomes will be much better.