- Among adults with relapsing-remitting multiple sclerosis (MS), initiation of high-efficacy therapy within 2 years of clinical onset, as compared with 4-6 years, reduces disability longer term.
Why this matters
- According to the treatment escalation paradigm, high-efficacy therapies are usually initiated only after first-line disease-modifying therapies fail.
- Editorial: evidence points to a "short and early window of therapeutic opportunity," but much remains to be clarified.
- High-efficacy therapy started:
- Early in 51%.
- Late in 49%.
- Baseline mean Expanded Disability Status Score (EDSS) scores were almost identical between the early (2.18) and late (2.06) groups.
- With median follow-up of 7.8 years, mean EDSS score was lower in the early vs the late group:
- 6 years after disease onset: 2.2 vs 2.9 (P<.0001>
- 10 years after disease onset: 2.3 vs 3.5 (P<.0001>
- Retrospective cohort study, adults with relapsing-remitting MS starting high-efficacy therapy (rituximab, ocrelizumab, mitoxantrone, alemtuzumab, natalizumab):
- 308 from international MSBase registry.
- 236 from Swedish MS Registry.
- Comparison with propensity-score matching: start early (0-2 years) vs late (4-6 years) after clinical disease onset.
- Main outcome: disability.
- Funding: National Health and Medical Research Council Australia; MS Society UK.
- Potential residual, unmeasured confounding.
- Uncertain generalizability.
- Greater use of certain high-efficacy therapies.