Time to treatment and prognosis of multiple sclerosis beyond physical disability

Introduction: Multiple sclerosis (MS) stands as the most common non-traumatic debilitating condition affecting young adults, with its global incidence on the rise. This trend contributes to its significant socioeconomic impact, related to physical disability and cognitive dysfunction. Investing in early diagnosis and treatment holds promise for reducing the daily limitations faced by affected individuals.  

Objectives: Statistically elucidate the true long-term impact that the time gap between the initial onset of symptoms and treatment has on prognosis. 

Methods: This is a multicenter study, in which MS patients were ambispectively analyzed from three outpatient clinics. The time gap from disease onset to first disease modifying treatment (TFDT) and the time between disease onset and first high-efficacy therapy (TFET) were calculated. Socio-demographic and clinical data were collected through the local database, and the course of the disease was evaluated by using classical physical/cognitive disability scales and burden symptoms questionnaire (SymtoMScreen) .  

Results: A total of 184 MS patients were included in the baseline analysis (77.7% females; mean/standard deviation (SD) age at analysis was 39.1(10.8) years; mean/SD age at disease onset was 29.8(9.4) years; mean disease duration of 9.3(7.6) years; median baseline EDSS score was 2.0. Significant correlations were observed between: TFDT with EDSS (r=0.374, p<0.001); TFET and EDSS (r=0.442, p<0.001); TFDT and processing speed (r=-0.207; p=0.042); TFDT and visual memory (r=-0.271; p=0.008); and TFET and SypmtoMScreen (r=0.203, p=0.049). No significant correlations were observed between both time intervals with the Modified Fatigue Impact Scale (MFIS) and the Multiple Sclerosis Impact Scale (MSIS-29). 

Conclusions: A longer time to start treatment is associated with worse physical disability, cognitive dysfunction and symptoms severity. These findings may support decisions regarding the need for early MS therapy in a Brazilian setting, beyond just the classic physical outcomes.