#ClinicSpeak & #BrainHealth: how much more data do we need to convince people to treat MS early?

Time is brain; can we really afford not to treat MS early? May be we need a high-profile legal case to change behaviour? #ClinicSpeak #BrainHealth #MSBlog

I get quite tired of saying 'early effective treatment', 'treat-2-target of NEDA (no evident disease activity)', 'shredding reserve', 'brain health',  'time is brain', 'MS is a preventable dementia', etc. The Swedish registry data below provides yet more real-life data showing that delayed treatment has a price. Those MSers who started treatment 3-years from disease onset were much more likely to reach a disability outcome compared to MSers who started treatment within a year of MS onset. This data supports the 21-year mortality data of the pivotal interferon-beta-1b trial that showed that those subjects who had to wait 3-years to be treated with interferon were ~50% more likely to be dead at 21 years compared to those subjects who were treated earlier. Importantly, the majority of the deaths (75%) in this study were MS-related and not due to some other effect of interferon-beta. 

Despite the overwhelming evidence supporting early treatment there are still healthcare systems and individual HCPs who delay access to treatments. Often this is based on the assumption that a lot of MSers will turn out to have benign disease and therefore if you treat early you will be treating MSers with benign disease who don't need a DMT. I hope we have convinced you over the many years of running this blog that there is very little data to support this position or dare I say misconception. If you take a 40+ year view of MS there are very few MSers who turn-out to have benign MS. The primary motivation behind our 'Brain Health: Time Matters' policy document was to counteract this surprisingly pervasive misconception. If you have not done so already I would urge you to read the document and to pledge your support. We need numbers to make things happen. Thank you. 

Kavaliunas et al. Importance of early treatment initiation in the clinical course of multiple sclerosis. Mult Scler. 2016 Oct 17. pii: 1352458516675039.

OBJECTIVES: The aim of this study was to identify factors influencing the long-term clinical progression of multiple sclerosis (MS). A special objective was to investigate whether early treatment decisions influence outcome.

METHODS: We included 639 patients diagnosed with MS from 2001 to 2007. The median follow-up time was 99 months (8.25 years). Cox regression models were applied to identify factors correlating with the outcome variable defined as time from treatment start to irreversible score 4 of the Expanded Disability Status Scale (EDSS).

RESULTS: Patients initiated on treatment later had a greater risk of reaching EDSS 4 (hazard ratio of 1.074 (95% confidence interval (CI), 1.048-1.101)), increased by 7.4% for every year of delay in treatment start after MS onset. Patients who started treatment after 3 years from MS onset reached the outcome sooner with hazard ratio of 2.64 (95% CI, 1.71-4.08) compared with the patients who started treatment within 1 year from MS onset. Baseline EDSS and age at onset were found to be predictive factors of disability progression.

CONCLUSION: Early treatment initiation was associated with a better clinical outcome. In addition, we confirmed the well-established prognostic factors of late age at onset and early disability.

CoI: multiple

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