Early versus later treatment start in multiple sclerosis: a register-based cohort study

European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies
T A ChalmerDanish Multiple Sclerosis Group

Abstract

To assess long-term treatment effectiveness of disease-modifying therapy (DMT) initiated early in disease course versus later treatment start. We included all Danish patients with multiple sclerosis (MS) treated with DMT through two nationwide population-based MS registries. Patients were categorized as early treated if treatment started within 2 years after the first MS symptom (n = 2316) and later treated if treatment started between 2 and 8 years after clinical onset (n = 1479). We compared time from treatment start to progression to an Expanded Disability Status Scale (EDSS) score of 6 and mortality between cohorts as hazard ratio (HR) using a Cox proportional hazards model with adjustment for stabilized inverse probability of treatment weights. Several sensitivity analyses were conducted. The median follow-up time of 3795 patients was 7.0 (range 0.6-19.5) years for the EDSS score of 6 outcome and 10.4 (range 1.2-20.1) years for the mortality outcome. Patients with later treatment start showed a 42% increased hazard rate of reaching an EDSS score of 6 compared with the early-treated patients [HR, 1.42; 95% confidence interval (CI), 1.18-1.70; P < 0.001]. When stratified by sex, the increased hazard among later-treated women...Continue Reading

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May 14, 2019·Multiple Sclerosis : Clinical and Laboratory Research·Tine Iskov KoppMelinda Magyari
Nov 16, 2019·Journal of Neurology, Neurosurgery, and Psychiatry·Thor Ameri ChalmerMelinda Magyari
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Sep 30, 2021·Nature Reviews. Neurology·Nils Koch-Henriksen, Melinda Magyari

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