Barcelona, Spain—Starting medications for MS earlier in the course of the disease appears to lower the risk of later disability, according to a new study.

“When it comes to MS treatment, the earlier the better,” stated study author Alvaro Cobo-Calvo, MD, PhD, of the Multiple Sclerosis Center of Catalonia and the Autonomous University of Barcelona in Spain. “Our study found that starting treatment within six months after the first symptoms is associated with a lower risk of disability over time.”

The report in the journal Neurology pointed out that past studies suggested early treatment is associated with better long-term outcomes in patients with a first demyelinating event and early MS, but magnetic resonance (MR) findings were not usually integrated to construct propensity scores (PS) when evaluating outcomes. In this study, the University of Barcelona–led researchers assessed the association of receiving very early treatment with the risk of long-term disability including an MR Score (MRS) in patients with a first demyelinating event.

The study team included 580 patients with a first demyelinating event prospectively collected between 1994 and 2021; all received at least one disease-modifying drug (DMD). Patients were classified into tertiles according to the cohort’s distribution of the time from the first demyelinating event to the first DMD:

• First tertile (FT) or very early treatment (6 months; n = 194)
• Second tertile (6.1-16 months, n = 192)
• Third tertile (TT; 16.1 months, n = 194).

The researchers constructed a five-point MRS to the sum of the following indicators: ≥9 brain lesions (1 point); ≥1 infratentorial lesion (1 point); ≥1 spinal cord (SC) lesion (1 point); ≥1 contrast-enhancing (CE) brain lesion (1 point); ≥1 CE SC lesion (1 point).

The results confirmed that very early treatment decreased the risk of reaching EDSS (Expanded Disability Status Scale) 3.0 (hazard ratio [HR] 0.55; 95% CI, 0.32; 0.97); secondary progressive MS (HR 0.40; 95% CI, 0.19; 0.85); and sustained disease progression at 12 months after treatment initiation (HR 0.50; 95% CI, 0.29; 0.84) when compared with patients from the TT group.

“Patients from the FT had a lower disability progression rate (β estimate, –0.009 [95% CI –0.016; –0.002]) and a lower severe disability measured by the PDDS (β estimate, –0.52 [95% CI –0.91; –0.13]) than the TT groups,” the authors wrote. “Finally, there was a 62.4% reduction in the median time between the first demyelinating event and the first-ever treatment initiation from patients displaying a raw-MRS 1 to patients with a raw-MRS 5.”

The researchers concluded that by using PS models with and without MRS, they demonstrated that treatment initiation at very early stages is associated with a reduction in the risk of long-term disability in patients with a first demyelinating event. The results provided class III evidence that earlier treatment of MS patients presenting with a first demyelinating event is associated with improved clinical outcomes, they added.

“Altogether, our results support the robustness and effectiveness of very early treatment to halt long-term disability progression, and stress that earlier detection and treatment is encouraged,” Dr. Cobo-Calvo said.

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