- A recent study finds getting treatment early for multiple sclerosis could help reduce the risk of long-term disability by 45%.
- In MS, the cells of the immune system mistakenly attack myelin, the protective sheath that insulates and protects the nerve fibers, or axons.
- In some cases, people with MS can develop partial or complete paralysis and need to use a wheelchair.
People who started taking medication earlier after the first signs of multiple sclerosis (MS) had a 45% lower risk of long-term disability, a recent study found.
In MS, the cells of the immune system mistakenly attack myelin, the protective sheath that insulates and protects the nerve fibers, or axons.
This can cause symptoms such as vision problems, muscle weakness, tingling or numbness in the limbs, difficulty with balance while walking, and bladder control problems.
In some cases, people with MS can develop partial or complete paralysis and need to use a wheelchair. This is more common with untreated or advanced disease.
“When it comes to MS treatment, the earlier, the better,” said study author Dr. Alvaro Cobo-Calvo, of the Multiple Sclerosis Center of Catalonia and the Autonomous University of Barcelona in Spain, in a release.
“Our study found that starting treatment within six months after the first symptoms is associated with a lower risk of disability over time.”
The observational study was published online July 19 in Neurology, the medical journal of the American Academy of Neurology.
For the study, researchers reviewed past data on 580 people under age 50 who experienced a first episode of symptoms that were likely due to MS and could not be attributed to other diseases.
All people were eventually treated with at least one disease-modifying drug.
Researchers divided people into three groups: those treated within six months after their first episode; those treated between six months and 16 months; and those treated after more than 16 months.
They also examined data on people’s disability levels, and brain scans looking for damage to the brain and spinal cord due to MS.
Researchers followed people for 6 to 17 years, with an average of 11 years and rated their disability scores. These scores range from zero to 10, with higher scores indicating greater disability.
People treated within six months after their first episode were less likely to reach a disability score of 3 by the end of the study, compared to those who were in the group with the longest delay in treatment.
A score of 3 indicates people have no problem walking but have moderate disability in one function or mild disability in three or four functions. These functions include muscle weakness, balance and coordination, and bladder control
People in the earliest treatment group were also less likely to develop secondary progressive multiple sclerosis (SPMS), in which neurologic function and disability steadily worsen.
In addition, these people were more likely to remain stable at their disease level one year after the start of treatment.
People treated earlier also had a lower rate of disability progression and a lower level of severe disability in a self-reported test, researchers found.
Dr. Jay Avasarala, neurologist and director of the MS and neuroimmunology team at the Kentucky Neuroscience Institute at UK HealthCare in Lexington, said the results of the study are not surprising.
“Neurologists who treat MS and who are fellowship trained know that treatment early and with high-efficacy drugs probably are the best over time for patients,” he told Healthline.
In addition, Dr. Lana Ryerson, a neurologist with a special focus in MS at Hackensack Meridian Jersey Shore University Medical Center in Neptune, New Jersey, said the new research suggests that “even with MS patients that we would not necessarily be worried about — [based on laboratory tests or imaging results] — they’re still in trouble if we don’t start disease-modifying therapy thoroughly.”
She said, in practice, the study may change how she talks to patients about the potential progression of their disease.
Previously, “when I counseled a patient who may not have aggressive [signs of disease], I may not have been as outspoken about the disease progression and what their potential future might look like if we don’t start medications as soon as possible,” she told Healthline.
“But I think this study may shift how I’m counseling MS patients who initially I was not that worried about,” she added.
A key step in treating people with MS earlier is diagnosing them earlier. Ryerson said over the long time period of the study — between 1994 and 2021 — “the diagnostic criteria have changed so we are able to make the MS diagnosis sooner.”
Avasarala said early diagnosis is not an issue at the University of Kentucky because of the testing protocol they use.
In addition, “we speed up the diagnosis by doing testing on the same day,” he said. “It cannot get faster than that, but that is for patients who are admitted to the hospital.”
In support of this approach, some MS patients that his clinic sees are able to receive medications at no cost due to patient assistance programs at the university. This helps ensure they are treated earlier.
A recent study finds getting treatment for MS within six months of when symptoms appear decreases the likelihood of developing disabling symptoms by 45%.