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STUDY: Does starting a DMT sooner delay irreversible disability in MS? "Confirmed"

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  • STUDY: Does starting a DMT sooner delay irreversible disability in MS? "Confirmed"

    Big Multiple Sclerosis Data Network: impact of early treatment on long term disability accumulation in relapsing remitting multiple sclerosis patients

    ECTRIMS Online Library. Iaffaldano P. Oct 27, 2017; 199874

    Abstract: P1854
    Type: Poster
    Abstract Category: Late breaking news

    Background: Results from different randomized clinical trials support the early treatment of multiple sclerosis (MS). To date no real-life data have been provided to support the very long-term impact of such treatment strategy.

    Objectives: A pilot study using data pooled from 5 different MS registries, the Big MS Data (BMSD) Network evaluated the impact of the time to the first disease modifying drug (DMD) start on the long term disability accumulation in relapsing MS (RRMS).

    Methods: A cohort of first-line DMD-treated (Interferon-beta, Glatiramer Acetate, Azathioprine) RRMS patients, with a minimum follow-up of 10 years, a minimum cumulative DMDs exposure of 3 years and at least 3 Expanded Disability Status Scale (EDSS) score evaluations was selected from the pooled cohort of the BMSD Network. Cox proportional hazards regression models were used to assess the risk of reaching the EDSS 4.0 and 6.0 including as covariates: age at onset, sex, baseline EDSS, number of relapse before DMD start, number of relapses after DMD start (included as time-dependent covariate), time from disease onset to the first DMD start (included as quintiles) and the number of EDSS evaluations performed during the follow-up.

    Results: A cohort of 12,286 RRMS patients (Female 8,625 (70.4%)) was retrieved. The median(Interquartile range) follow-up was 13.6(11.7-16.2) years, the median time to the first DMD start was 4.4(1.7-9.6) years, the median DMD exposure was 9.2(5.7-12.2) years. The 1st quintile of time to DMD start included patients treated within 1 year after the disease onset (0.7(0.4-1.0) years). During the follow-up an irreversible EDSS score of 4.0 and 6.0 was reached by 3,677 (34.6%) and 2,193 (18.3%) patients, respectively. The multivariate models for the risk of attaining EDSS 4.0 and EDSS 6.0 both revealed a significant association with the time to first DMD start. Patients belonging to the 2nd, 3rd, 4th and 5th quintile of the time from disease onset to the first DMD start were all at higher risk for developing irreversible disability (EDSS 4.0: HR 95% CI: 1.23(1.10-1.37), 1.35(1.21-1.51), 1.51(1.34-1.69), 1.81(1.60-2.06), respectively; EDSS 6.0: 1.26(1.07-1.49), 1.53(1.31-1.79), 1.76(1.50-2.06), 1.96(1.65-2.32), respectively) in comparison to patients belonging to the 1st quintile.

    Conclusions: Real-world data from the BMSD network confirm the effectiveness of the early treatment strategy in delaying the accumulation of irreversible disability in RRMS patients.

    Dave Bexfield

  • #2
    Not Surprised

    In my own case, I was injecting Beta-Interferon within 2 weeks of diagnosis after my first major M.S. symptoms presented themselves; numbness, profound weakness on the left side, poor gait etc.

    I've stayed stable for over 15 years on it. Yes I have good days and bad days, but am largely stable. I'll keep taking it as long as I can get it out of my insurance company!
    Retired engineer, now hobby farmer with goats, chickens, an old dog,and a lazy barn cat!
    Watch my goats at
    Active in amateur radio
    Linux geek, blogging at
    M.S. since 2000