Proceedings of the 25th BCTRIMS Annual Meeting

Background: Treatment strategy for Multiple Sclerosis (MS) is a highly controversial debate. Disease-modifying therapies for MS are divided into escalation therapies and early high-efficacy therapies. Observational studies suggest that early use of high efficacy therapy improves long-term outcomes.

Objective: We aim to evaluate clinical disability in relapsing-remitting multiple sclerosis (RRMS) patients treated with early high-efficacy disease-modifying therapies (heDMT).

Methods: RRMS patients with ⩾ 4-year of follow-up and ⩾3 visits after disease modifying therapy (DMT) start were selected from the HUOL/UFRN MS Registry. These patients were followed since 2006, with visits every 3-6 months. We include naïve-individuals treated with heDTM and patients in which heDMT was started within the first 2 years of therapy. Drugs considered as heDMT were: fingolimod, natalizumab, ocrelizumab, rituximab, alemtuzumab, cladribine and mitoxantrone. The effect of heDMT was measured by the 4-year change in Expanded Disability Status Scale (EDSS) score and 10-meter walk test (10MWT). We also assessed outcomes in groups of patients who started heDMT before 5 years of disease and after more than 5 years of disease.

Results:A total of 38 patients were included in this study. At baseline, median EDSS score was 1.5 (0-3 IQR) and median 10MWT  was 9.7 (8.2-18 IQR). After 4 years of treatment onset, median EDSS score was 1.7 (0-4.5 IQR) and median 10MWT was 10 (8.4-37 IQR). When we evaluate outcomes in groups based on delay in starting treatment, after 4 years of treatment onset, median EDSS score in the <5 years delay group was 1.5, versus 2 in >5 years delay group (p=0.0440).

Conclusion: Our results are similar to studies evaluating early use of heDMT, with mean EDSS score of 1.5-2. Early treatment with heDMT may improve long-term outcomes by minimizing the accumulation of disability early in the disease course.