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This study finds delaying MS treatment is a lot like jumping into a pool full of piranhas. You might be fine, but you probably shouldn't bet on it. - D
Importance of early treatment initiation in the clinical course of multiple sclerosis
A. Kavaliunas1, A. Manouchehrinia1, L. Stawiarz1, R. Ramanujam1,2, J. Agholme1, A.K. Hedström3, O. Beiki1, A. Glaser1, J. Hillert1 1Clinical Neuroscience, Karolinska Institutet, 2Department of Mathematics, KTH Royal Institute of Technology, 3Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
Background: Although disease modifying drugs (DMDs) have proven efficacy in randomised controlled trials, it is still not definitively shown that they influence the long term outcome of MS. It is also possible, albeit not proven, that the “natural course” of MS in general is influenced by the wide-spread use of DMDs. Therefore it is less clear to what extent the classical predictors of disability are still relevant in a situation where the majority of patients receive DMD treatment.
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 at the department of Neurology in the Karolinska University Hospital and former Huddinge University Hospital (Stockholm, Sweden). 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), as well as time to EDSS 6.
Results: Patients initiated on treatment later had a greater risk of reaching EDSS 4 (hazard ratio of 1.067 (95% CI 1.044−1.091)), increased by 6.7% for every year of delay in treatment start after MS onset. Patients that started treatment after 3 years from MS onset reached the outcome sooner with hazard ratio of 2.43 (95% CI 1.60−3.69) compared with the patients that started treatment within 1 year from MS onset. Similar results were obtained by analyzing time to EDSS 6. Baseline EDSS and age at onset were found to be predictive factors of disability progression. Gender (male) was associated with a greater risk to reach EDSS 6 only.
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.
Importance of early treatment initiation in the clinical course of multiple sclerosis
A. Kavaliunas1, A. Manouchehrinia1, L. Stawiarz1, R. Ramanujam1,2, J. Agholme1, A.K. Hedström3, O. Beiki1, A. Glaser1, J. Hillert1 1Clinical Neuroscience, Karolinska Institutet, 2Department of Mathematics, KTH Royal Institute of Technology, 3Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
Background: Although disease modifying drugs (DMDs) have proven efficacy in randomised controlled trials, it is still not definitively shown that they influence the long term outcome of MS. It is also possible, albeit not proven, that the “natural course” of MS in general is influenced by the wide-spread use of DMDs. Therefore it is less clear to what extent the classical predictors of disability are still relevant in a situation where the majority of patients receive DMD treatment.
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 at the department of Neurology in the Karolinska University Hospital and former Huddinge University Hospital (Stockholm, Sweden). 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), as well as time to EDSS 6.
Results: Patients initiated on treatment later had a greater risk of reaching EDSS 4 (hazard ratio of 1.067 (95% CI 1.044−1.091)), increased by 6.7% for every year of delay in treatment start after MS onset. Patients that started treatment after 3 years from MS onset reached the outcome sooner with hazard ratio of 2.43 (95% CI 1.60−3.69) compared with the patients that started treatment within 1 year from MS onset. Similar results were obtained by analyzing time to EDSS 6. Baseline EDSS and age at onset were found to be predictive factors of disability progression. Gender (male) was associated with a greater risk to reach EDSS 6 only.
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.
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