Early DMT Initiation in MS Tied to Favorable Patient-Reported Outcomes

Patient-reported outcomes were improved with earlier initiation of disease-modifying treatment (DMT) in the setting of multiple sclerosis (MS), according to results of a nationwide survey, published in the Journal of Neurology, Neurosurgery & Psychiatry.

In recent years, there has been growing focus on the importance of patient-reported outcome measures (PROMs). Early use of DMTs has been associated with reducing the accumulation of long-term disability, however, little is known about the patient’s perspective of early DMT outcomes.

For this study, researchers from Karolinska Institute in Sweden sourced data from the Swedish MS registry, which is a national database of approximately 80% of the country’s patients with MS that was started in 2001. Since 2007, the registry started collecting PROMs. For this study, researchers compared PROMs between patients with relapsing MS (N=7849) who started DMTs early (first 2 years of onset) and those who started late (2-4 years after diagnosis). A propensity-matching strategy was used to balance for cohort differences.

The early (n=886) and late (n=179) cohorts comprised patients with a mean age, 35.32 (standard deviation [SD], 9.99) and 35.23 (SD, 9.37) years at MS onset, and 28.9% and 27.9% were men, respectively. The median Expanded Disability Status Scale (EDSS) scores at baseline were 1.50 (interquartile range [IQR], 0.50-2.00) points for patients who started DMTs earlier and 1.00 points (IQR, 0.00-2.00) for those who started DMTs later.

At an average of 7.4 years after disease onset, patients who started DMTs early reported Multiple Sclerosis Impact Scale (MSIS) physical scores of 17.78 (95% CI, 13.39-23.60) compared with 23.29 (95% CI, 19.38-28.09), which was 1.31-fold higher score (95% CI, 1.09-1.58; P =.004). These values indicated that patients who started DMTs later perceived their physical symptoms as more problematic than those who started treatment earlier.

Similarly, patients who received early treatment reported a MSIS psychological score that was 1.14-fold (95% CI, 0.97-1.34; P =.102) lower (mean, 26.41; 95% CI, 20.71-33.68) compared with those treated later (mean, 30.11; 95% CI, 25.62-35.39).

For quality-of-life outcomes, patients in the early-treated group reported similar Euro-QoL-5 (EQ-5D) Visual Analogue Scale (VAS) scores as those in the late-treated group (mean, 71.63 [95% CI, 67.02-76.56] vs mean, 66.62 [95% CI, 60.89-72.35]; P =.089), respectively.

As expected, functional outcomes favored early DMT treatment (mean EDSS, 1.27; 95% CI, 1.12-1.42) compared with late treatment (mean EDSS, 1.62; 95% CI, 1.37-1.86; P =.005).

When data were analyzed as continuous exposure from MS onset, every year in DMT delay was associated with a 2.75-point change in MSIS physical score (P <.001), 0.15-point change in EDSS score (P =.004), 2.02-point change in MSIS psychological score (P =.024), and -2.18-point change in EQ-5D VAS score (P =.146).

Results were similar in a non-propensity-matched sensitivity analysis.

This study may have been limited by the small sample sizes in the propensity-matched analysis.

These data indicated that among patients with relapsing MS, delaying DMT initiation had detrimental outcomes on long-term PROMs relating with physical and psychological symptoms. However, there was little apparent effect on general quality of life.

The researchers concluded that their findings suggest “[P]atients’ experience of physical MS symptoms may be congruent to their clinician determined disease severity, and benefit from early initiation of treatment.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.