As many of you know, I got a stem cell transplant four years after diagnosis. But the damage had been done. In the spring of 2009 I was an EDSS 3.0. That fall? A 6.0. I barely qualified for the trial at a 5.5. Today? A 7.0 and I use a wheelchair full time.
The transplant held for four years, but if I had been able to initiate stronger treatment earlier, I might still be walking today. Do not underestimate this disease. Do not underestimate the importance of prompt treatment. Do not underestimate the importance of high intensity treatment. Do not.
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An argument for broad use of high efficacy treatments in early multiple sclerosis
For those who are recently diagnosed with MS, this might be the most important paper you'll ever read. -D
Journal of Neurology
An argument for broad use of high efficacy treatments in early multiple sclerosis
James M. Stankiewicz, Howard L. Weiner
First published November 22, 2019, DOI: https://doi.org/10.1212/NXI.0000000000000636
Abstract
Two different treatment paradigms are most often used in multiple sclerosis (MS). An escalation or induction approach is considered when treating a patient early in the disease course. An escalator prioritizes safety, whereas an inducer would favor efficacy.
Our understanding of MS pathophysiology has evolved with novel in vivo and in vitro observations. The treatment landscape has also shifted significantly with the approval of over 10 new medications over the past decade alone. Here, we re-examine the treatment approach in light of these recent developments.
We believe that recent work suggests that early prediction of the disease course is fraught, the amount of damage to the brain that MS causes is underappreciated, and its impact on patient function oftentimes is underestimated. These concerns, coupled with the recent availability of agents that allow a better therapeutic effect without compromising safety, lead us to believe that initiating higher efficacy treatments early is the best way to achieve the best possible long-term outcomes for people with MS.
FULL ARTICLE (FREE):
https://nn.neurology.org/content/7/1/e636
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