Long-term multiple sclerosis treatment: Understanding prognosis, effects and therapies

Early treatment for patients with multiple sclerosis reduces the number and severity of flare-ups and delays disease progression.

Early treatment for patients with multiple sclerosis (MS) reduces the number and severity of flare-ups, delays disease progression and is associated with decreased long-term disability from neurological deficits compared with MS patients who did not begin treatment early.

“Getting and staying on disease-modifying therapy is important, even when no symptoms are present, because the disease always remains present in the central nervous system,” said Roman M. Kassa, M.D., multiple sclerosis specialist and neurologist with Norton Neuroscience Institute.

For that reason, referring patients to specialty MS care benefits younger patients even if they are asymptomatic, so they can get on a disease-modifying  treatment plan.

Understanding multiple sclerosis and its long-term effects

Delaying relapses and the accrual of disability by beginning treatment early can have a significant effect over the long term. One study found relapse resulted in a 31% to 48% increase in the risk of disability-worsening events in the year that followed, compared with a year without relapses.

“Studies indicate that clinical relapses and accrual of MS lesions in the brain and spinal cord contribute to the accumulation of disability in patients with MS, particularly early on,” Dr. Kassa said.

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In people who have had one relapse with neurological symptoms consistent with MS, initiating a disease-modifying therapy has been shown to delay conversion to clinically definite MS. Early treatment also reduces the number of active lesions that develop on the brain.

Early treatment is only half the equation, however. Research studies show it’s not only starting treatment early, but sticking with it over time that benefits patients with MS. Delays in starting a disease-modifying therapy and a lack of adherence to treatment both may be associated with poor patient outcomes.

A French study looking at more than 2,000 MS patients beginning, on average, at age 33, found continued disease-modifying therapy is associated with a lower risk of disability. Patients who received continuous treatment for 15 years starting 20 years earlier decreased the risk of irreversible disability by 26% and secondary progressive MS by 34%, compared with a five-year treatment started 10 years earlier.

Maintaining overall good health is also important for patients with MS.      Comorbidities such as diabetes or heart disease are associated with increased morbidity and mortality in MS patients. That means regular preventive health remains important for people with MS. This includes colonoscopies, and for women, Pap tests and mammograms.

Disease-modifying therapies for MS

Around 20 disease-modifying therapies are now approved by the Food and Drug Administration (FDA) for MS. Before the first disease-modifying therapies received FDA approval in the 1990s, 4 out of 5 people with MS needed a cane, walker or some other assistive device by age 65. With the latest treatments available, that figure is now around 1 in 5.

Preexisting disability and advanced age are the top risk factors for additional disability in MS patients. Preexisting disability and advanced age are also among the top risk factors for incomplete recovery from MS relapse.

Aging is also associated with the transition of MS from an inflammatory disease to a neurodegenerative disease. The natural weakening of the immune system that occurs with aging, immunosenescence, also may be a factor in this transition.

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