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STUDY: "DMDs delayed long-term disability in MS patients treated" early or late
Influence of treatments in multiple sclerosis disability: A cohort study
Eleonora Cocco Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Claudia Sardu University of Cagliari, Italy
Gabriella Spinicci MS Center, ASL 8, Cagliari, Italy
Luigina Musu MS Center, ASL 8, Cagliari, Italy
Rita Massa MS Center, ASL 8, Cagliari, Italy
Jessica Frau Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Lorena Lorefice Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Giuseppe Fenu Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Giancarlo Coghe Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Serenella Massole MS Center, ASL 8, Cagliari, Italy
Maria Antonietta Maioli MS Center, ASL 8, Cagliari, Italy
Rachele Piras Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Marta Melis Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Gianluca Porcu MS Center, ASL 8, Cagliari, Italy
Elena Mamusa MS Center, ASL 8, Cagliari, Italy
Nicola Carboni MS Center, ASL 8, Cagliari, Italy
Paolo Contu University of Cagliari, Italy
Maria Giovanna Marrosu Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Abstract
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 using Cox regression analysis adjusted for propensity score and immortal time bias.
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.
Eleonora Cocco Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Claudia Sardu University of Cagliari, Italy
Gabriella Spinicci MS Center, ASL 8, Cagliari, Italy
Luigina Musu MS Center, ASL 8, Cagliari, Italy
Rita Massa MS Center, ASL 8, Cagliari, Italy
Jessica Frau Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Lorena Lorefice Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Giuseppe Fenu Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Giancarlo Coghe Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Serenella Massole MS Center, ASL 8, Cagliari, Italy
Maria Antonietta Maioli MS Center, ASL 8, Cagliari, Italy
Rachele Piras Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Marta Melis Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Gianluca Porcu MS Center, ASL 8, Cagliari, Italy
Elena Mamusa MS Center, ASL 8, Cagliari, Italy
Nicola Carboni MS Center, ASL 8, Cagliari, Italy
Paolo Contu University of Cagliari, Italy
Maria Giovanna Marrosu Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
Abstract
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 using Cox regression analysis adjusted for propensity score and immortal time bias.
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.
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