Early Treatment Staves Off Later Disability in Patients With MS, Study Finds

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Clinically isolated syndrome (CIS) is the term used to describe the first sign of multiple sclerosis (MS)-like symptoms. These can include numbness, tingling, muscle weakness, or balance problems. Current standard treatment for CIS includes MS disease-modifying therapy, which is believed to delay disease progression. However, the optimal time to begin treatment for people with CIS is unclear.

In a study recently published in Neurology, lead author Alvaro Cobo-Calvo, M.D., Ph.D., and his colleagues from the Multiple Sclerosis Center of Catalonia and the Autonomous University of Barcelona in Spain investigated the relationship between early treatment and the risk for long-term disability in patients with CIS.

The researchers analyzed data for 580 patients who had experienced an episode of CIS between 1994 and 2021. Participants were 16 through 50 years of age at the time of first symptoms, and all received at least one disease-modifying treatment after the CIS episode.

Participants were divided into three groups based on when they began treatment after the onset of symptoms. The first group of 194 patients received treatment within six months of experiencing symptoms. The second group included 192 participants who began treatment six to 16 months after initial symptoms, and the third group consisted of 194 patients who started treatment more than 16 months after the CIS episode.

The researchers monitored the patients’ brain scans and disability levels for an average of 11 years. Disability scores ranged from zero to 10 on the Expanded Disability Status Scale (EDSS), where higher scores indicated greater disability.

The study results showed that people who started treatment within 6 months of initial symptoms were 45% less likely to reach an EDSS level of 3 by the end of the study than those who started treatment after 16 months. An EDSS level of 3 indicates moderate disability where the person can walk without assistance but may have moderate disability in one of eight areas, including vision, thinking skills, or motor function, or mild disability in three or four areas.

Additionally, the group that received the earliest treatment had a 60% lower risk of advancing from relapsing-remitting MS to secondary progressive MS compared with those in the latest treatment group. Participants who received treatment within six months of symptoms were also 50% more likely to remain at stable disease levels one year after initial treatment versus those in the latest treatment group.

Cobo-Calvo and his colleagues concluded that initiating treatment at very early stages can lower the risk of long-term disability in patients who have experienced CIS.

“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,” said Cobo-Calvo in a press release.

The authors acknowledge that the study only included patients who experienced an initial CIS episode between the ages of 16 and 50 years. Hence, the results cannot be extrapolated to patients with late-onset MS or those older than 50.