HealthDay News — Long-term outcomes are more favorable for early intensive treatment (EIT) versus first-line moderate-efficacy disease-modifying therapy (DMT) in multiple sclerosis (MS), according to a study published online February 18 in JAMA Neurology.

Katharine Harding, PhD, from Cardiff University in the United Kingdom, and colleagues examined long-term outcomes in a cohort study analyzing data for 592 patients with MS prescribed DMT. Patients were classified by first-line treatment strategy: high-efficacy (EIT) or moderate-efficacy DMT (escalation [ESC]).

The researchers found that compared with the ESC group, the EIT group had a lower mean 5-year change in Expanded Disability Status Scale score (0.3 vs 1.2); after adjustment for relevant covariates, this result remained significant (β= −0.85; 95% confidence interval, −1.38 to −0.32; P=.002). The median time to sustained accumulation of disability (SAD) was 6.0 and 3.14 years for EIT and ESC, respectively (P=.05). The median time to SAD was 3.3 years for those within the ESC group who escalated to high-efficacy DMT as second-line treatment (compared with EIT, group log-rank test P=.08). Of those who escalated to high-efficacy DMT, 60% developed SAD while still receiving initial moderate-efficacy treatment before escalation. 

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“Our study undermines the prevalent belief that an escalation approach represents a lower-risk strategy to MS treatment and suggests that in the real world, an escalation approach to DMT may be inadequate to prevent unfavorable long-term outcomes,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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