Isn't it time to consider early effective treatment as preventive therapy? #MSBlog #MSResearch #ClinicSpeak
"The follow-up study below in CISers indicates that those who have further attacks and develop disability have reduced quality of life at 10 years. The quality of life assessment looked at physical, mental, fatigue and pain scores. As this is the extension study of the original Avonex CIS study some of the CISers received interferon-beta from the outset and a some only received it after their second attack. Once the study was closed all were offered interferon-beta therapy. This is another piece of data supporting the early initiation of DMTs in CIS. The latter has been common practice through-out the developed world since the early 2000s, but has only recently started to be adopted by UK neurologists. In fact we are only really allowed to offer DMTs to CISers if they are at high-risk of developing a second attack. Fortunately, what constitutes high-risk is left up to the discretion of the treating MSologist. This is where the problem lies; not all CISer can access an MSologist in the UK, because many, or is some areas most, CISers are not referred to MS experts. We are trying to change this. If neurologists and ophthalmologists starting using early effective therapy as preventive therapy, to prevent or delay SPMS, then they may change their practice. I personally think every CISer should be referred to a MSologist for an opinion."
BACKGROUND: The main clinical determinants of quality of life (QOL) 5 years after clinically isolated syndrome (CIS) are Expanded Disability Status Scale (EDSS) score and conversion to clinically definite multiple sclerosis (CDMS). The aim of this study was to determine the demographic, clinical, and magnetic resonance imaging (MRI) factors associated with QOL 10 years after CIS.
METHODS: Controlled High Risk Avonex® Multiple Sclerosis Prevention Study in Ongoing Neurologic Surveillance (CHAMPIONS) 10-year MSers were assessed for CDMS, EDSS score, MRI T2 activity, brain parenchymal fraction, and MSer-reported QOL. Associations were evaluated using analysis of variance models.
RESULTS: A second clinical event consistent with CDMS and higher EDSS scores at years 5 and 10 were associated with lower 36-item Short Form Health Status Survey (SF-36) Physical Component Summary scores at year 10 (P < .01). MSers with earlier onset of CDMS had worse MSer-reported Physical Component Summary, SF-36 Mental Component Summary, fatigue, and pain scores at year 10 than MSers with later or no onset of CDMS. Neither initial randomization group nor any MRI metrics assessed at baseline or during follow-up were associated with QOL at 10 years.
CONCLUSIONS: These results support the development of therapies for CISers that significantly reduce the risk of conversion to CDMS and the progression of physical disability to milestones as low as EDSS scores of 2.0.