A study of patients with aggressive multiple sclerosis at disease onset

[ActiveMSers]

Hindsight is brilliantly clear, but determining who gets aggressive MS is a big challenge. I was doing decently until I wasn't. Had I gone onto Tysabri right away maybe I would be in far better shape, but at the time the drug had just been introduced. This study just reinforces that if the disease is moving, you need to get aggressive asap. - D

A study of patients with aggressive multiple sclerosis at disease onset.

Kaunzner UW, Kumar G, Askin G, Gauthier SA, Nealon NN, Vartanian T, Perumal JS.

Abstract

OBJECTIVE:

Identify aggressive onset multiple sclerosis (AOMS) and describe its clinical course.

METHODS:

AOMS patients were identified from a multiple sclerosis (MS) database based on a set of criteria. The subsequent clinical course of AOMS patients was then reviewed with the goal of potentially identifying the best approaches to manage these patients.

RESULTS:

Fifty-eight of 783 (7.4%) patients in the MS database met the criteria for AOMS, and 43 patients who had complete data for the duration of their follow-up were included in the subsequent analysis. The mean duration of the follow-up was 54 months. Thirty-five patients (81%) were started on a conventional first-line agent (injectable therapies for MS). Only two of these 35 patients (5.7%) had no evidence of disease activity. Twenty-two of 35 patients suffering from refractory disease were switched to a more aggressive treatment (natalizumab, rituximab, alemtuzumab, cyclophosphamide). Eight patients were started on aggressive treatment as their initial therapy, and seven of these eight (87.5%) patients showed no evidence of disease activity.

CONCLUSION:

With recognition of the crucial significance of early optimal treatment during the potential window of opportunity for best long-term outcomes, we describe AOMS within 1 year of disease onset and discuss possible treatment considerations for these patients.

[Marinadca]

I totally agree with this. When I was first diagnosed with MS, Tysabri was a 3rd line treatment and off the table. I had a relapse and progressed on copaxone, luckily Gilenyia was approved a year after I started that drug so I was able to switch and treat aggressively.

It's only benign until it isn't, I think earlier aggressive treatment would be a huge benefit to the AOMS population and even those of us with a "milder" course who wish to aggressively treat the disease.

[Suebee]

I'm in agreement too, and glad they are looking at the data. My onset was so aggressive and I have no doubt that because they gave me everything possible it hastened my recovery and lessened my residual disability.
But how to determine aggressive is the question, as Dave points out.
I would like to know if the risk is heightened if a close family member had aggressive MS. My mother had aggressive PMS.