Evaluation of Early Initiation of Disease-Modifying Treatment for Patients with Multiple Sclerosis Within a Real-World Population for Long-Term Outcomes
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: There is varied practice with Disease-Modifying Treatment (DMT) for Multiple Sclerosis worldwide. We evaluated early DMT initiation within a real-world population for long-term outcomes. Method: The Scottish Multiple Sclerosis Register (SMSR) identified participants diagnosed with Relapsing Remitting Multiple Sclerosis (RRMS) in 2010/2011. We compared two groups of propensity-matched participants at diagnosis, who went on to receive either early treatment (<12 months from diagnosis) or late/never treated. Participants underwent detailed clinicoradiological evaluation and patient-reported outcome measures 11–13 years post-diagnosis. The primary outcome was mean Expanded Disability Status Scale (EDSS). Results: The SMSR identified 298 participants. A total of 141 had complete retrospective clinical data and 81 agreed to participate, with 32 successfully matched (16 pairs). Median time on DMT was 10.8 years (range 0.4–12.5) for those treated early and 4.0 (0–11.5) years for the late/never-treated group. A total of 7/16 (44%) never received a DMT of those not treated early. All early-treated participants commenced first-line DMT (5/16 subsequently escalated to second-line DMTs). Of those treated later (9/16), 7/9 participants (78%) commenced first-line and 2/9 s-line DMT. There were no serious adverse events identified with any DMT. There was no significant difference in the primary outcome, with mean EDSS 3.93 in the late/never-treated group vs. 4.53 in the early-treated group at 11–13 years post-diagnosis (p = 0.57). There was no significant difference in median change in EDSS from the time of diagnosis to prospective assessment between early and late/never-treated groups. Patient Reported Outcome Measurement Information System (PROMIS) scores for cognition favoured no early treatment (p = 0.02), whilst satisfaction with treatment choice favoured early treatment (p = 0.03). Conclusions: Our cohort did not show clear benefit with early DMT in RRMS, contrasting with other larger studies, with no significant differences between early and late/never-treated patients on clinicoradiological outcomes. Possible explanations include confounding by variables not included in matching and group allocation based on diagnosis date rather than first clinical symptom. Most participants were treated with injectable DMTs, not in keeping with current practice. A prospective, long-term follow-up deep phenotyping study would help characterise benefits of early DMT use, but this is clearly challenging in practice.
Source: Sclerosis
Authors: Menai McDonald, Angus D. Macleod, Paul Gallagher
Institution: University of Aberdeen
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,207
OpenAlex ID: W4415624337