Treating MS from disease onset

Recent EAN/ECTRIMS guidelines highlight the need for early introduction of disease-modifying treatment (DMT). However, a study presented at the EAN 2019 illustrated that this is still far from reality in clinical practice. The results showed that time to first DMT varies strongly across countries [1]. Another study illustrated the importance of timely management by showing that MS patients have an increased risk of death, with pneumonia being the most common cause [2].

The two studies were pointed out in a highlights session by Dr Kjell-Morten Myhr (Haukeland University Hospital, Norway). Stahmann et al. investigated the time to first DMT after diagnosis in 3 large MS registry populations: NARCOMS, United Kingdom (UKMSR), and Germany (GMSR) [1]. Inclusion criteria were a relapsing disease course, diagnosis in 2014 or later, and provided data on DMT and disability status. Criteria were met by 2,506 participants (325 in NARCOMS, 453 in UKMSR, and 1,728 in GMSR). Of those patients, 2,065 (82.4%) had started a DMT. The overall mean time to first DMT was shortest in Germany, followed by the UK, and NARCOMS (P<0.001). Only 6.5% of NARCOMS participants had not received a DMT 4.5 years after diagnosis, which was significantly less than in Germany (16.4%), and the UK (>29%). Time to first DMT was shortest for mild disability levels in Germany, moderate levels in the UK, and severe levels in NARCOMS.

A UK study matched 4,029 MS patients diagnosed from 2001-2015 with 39,874 non-MS patients. Incidence rates (IRs) and incidence rate ratios (IRRs) were calculated, and cumulative incidence curves for all-cause and cause-specific mortality after cohort entry generated [2]. During a median follow-up of 12.7 years, 369 MS patients and 1,653 non-MS patients died, at a mean age of 63 and 68 years, respectively. IRs of all-cause death were twice as high in MS patients (P<0.0001). While IRs were higher among older patients, IRRs were higher among younger patients. Pneumonia was the most common cause of death for MS patients and was nearly 5 times more common than non-MS patients. Cardiovascular death was slightly elevated among MS patients; death of cancer was not elevated.

1. 
   
   1. Stahmann A, et al. EAN 2019, EPR3078.
   2. Persson R, et al. EAN 2019, O1206.

 



Posted on 27 August, 201918 March, 2021