Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational cohort study

Study (n=6149) found high-efficacy therapy started within 2 years of disease onset linked to less disability after 6–10 years vs. started later in disease course (mean EDSS score 2.2 vs. 2.9 late group in 6th year; p<0.0001); difference persisted throughout each year of follow-up

SPS commentary:

A commentary notes these findings align with those of a recent real-life study in a large, well characterised cohort of patients with multiple sclerosis, which found that disability after 5 years was lower in patients starting high-efficacy treatment (alemtuzumab or natalizumab; n=104) than in those starting escalation treatment (interferons, glatiramer acetate, dimethyl fumarate, fingolimod, or teriflunomide; n=488). It suggests that taken together, these two studies encourage a reappraisal of treatment algorithms in patients with multiple sclerosis. It notes another factor that needs to be considered is the senescence of the immunological system, which can change treatment response depending on the patient's age. It concludes overall, the evidence suggests that in multiple sclerosis there might be a short and early window of therapeutic opportunity in which the biology of disease can be substantially modified to affect long-term clinical outcomes, but many aspects still need to be clarified, including the identification of the patient population that would benefit most from high-efficacy treatment; the type of treatment; the timing and duration of this treatment; safety issues; and monitoring and escape strategies.


The Lancet Neurology

Resource links: