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The Importance of Early Long-Term Treatment in Multiple Sclerosis

Research has found that starting disease-modifying therapy early and sticking with it long-term can improve treatment outcomes. By Kerry WeissMedically Reviewed by Jason Paul Chua, MD, PhDReviewed: June 14, 2022Medically ReviewedEarly, long-term treatment with disease-modifying therapies can help you live your best life with MS.Thomas Barwick/Getty ImagesMultiple sclerosis (MS) is a chronic, inflammatory autoimmune disease that affects the central nervous system (the brain and spinal cord). In MS, the immune system attacks the protective covering around the nerves of the brain and spinal cord. This can lead to inflammation that causes damage or scarring, known as plaques or lesions. These lesions then contribute to a variety of MS symptoms. These symptoms vary from person to person, but usually include fatigue, numbness and tingling, muscle stiffness, vision problems, trouble walking, and cognitive changes. Most people experience MS as an alternating pattern of flares, or exacerbations, of symptoms followed by symptom-free periods; this is known as relapsing-remitting MS (RRMS). Over time, some people who have RRMS develop worsening disease, known as secondary progressive MS. Others may experience a completely different path, where symptoms get steadily worse over time without letting up — known as progressive MS. Whatever the type, MS is a chronic disease, which means there’s no cure for it. There are, however, a wealth of medications that can treat symptoms, help prevent relapses, and slow the progression of the disease. The most important of these is a class of drugs called disease-modifying therapies (DMTs), which, research shows, are most effective when they’re started as soon as possible after a person is diagnosed with MS.

The Role of Disease-Modifying Therapies in MS

DMTs work by decreasing inflammation, which in turn helps reduce the frequency and severity of flares. The U.S. Food and Drug Administration approved the first of this class of drugs to treat MS in the 1990s. Since then, more than 20 DMTs have been approved for MS. This means there are plenty of DMT options to choose from when developing a comprehensive MS treatment plan. “When MS is not treated [with a DMT] or the DMT selected is not effective, relapses or damaging lesions can occur,” says Julie Fiol, associate vice president of healthcare access for the National MS Society. “The disability that accumulates in MS is from relapses and lesions in the central nervous system. Preventing these can delay or prevent disability.” For example, before DMTs became available, more than 80 percent of people living with MS needed some sort of assistive device, such as a cane or walker, by age 65 in order to get around. Once the first round of DMTs became available, that number decreased to 60 percent. And as higher-efficacy DMTs have become available, as few as 20 percent of people who have MS need help to walk.

Why You Should Start Early DMT Treatment

For most people diagnosed with MS, starting on a DMT as soon as possible is ideal. MS is a highly inflammatory condition, especially early on, explains Fiol. “Early intervention with a DMT during this inflammatory state has been very effective for reducing disease activity and disability progression.” In fact, research shows DMTs are more effective when started early on in the course of the disease. Meanwhile, continuing with DMT therapy long-term can help prevent further inflammation that triggers relapses or flares, which may otherwise lead to new or worsening MS lesions and symptoms.

The Importance of Sticking With DMT Treatment Over Time

Although the short-term efficacy of DMTs in MS is well established, less is known about how well they work in the long-term. Early evidence is promising, though. For example, a study published in October 2021 in the journal Multiple Sclerosis looked at how treatment timing and duration impacts long-term outcomes in MS. The research showed starting treatment early and sticking with it over time were both important. However, the study also found long-term treatment with DMTs offered the strongest benefit for delaying disability and progression, even more so than starting DMT treatment early. And these treatments are safe. “Long-term safety of many of the DMTs is also established,” explains Fiol. “Although several DMTs have become available in the past five years, many have been used safely for over 10 years.”

Making Treatment Decisions Work With Your Doctor

Because research has found early access to high-efficacy DMTs in particular can result in the best treatment outcomes, many healthcare providers recommend starting on these drugs as soon as MS is diagnosed. However, it’s important to work with your doctor to weigh the benefits of the drugs with the risks of side effects to decide on a treatment approach that best suits your needs. Another major consideration: DMTs must be taken exactly as prescribed in order to be most effective. So it’s important to find a treatment option you’ll be able to stick with, whether that’s an injection, infusion, or oral option. That said, it’s not always clear who will respond best to one DMT over another. And a DMT that works well to control your MS today may become less effective over time. The good news? Having so many options allows room for trial and error. If one DMT doesn’t work, you can make a switch to try another. All in all, treating MS requires a very individualized approach. This is why it’s important to work with your doctor to find the treatment option that best suits your needs, monitor how well your treatment is working over time, and make adjustments as needed along the way.

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