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Early treatment with intensive therapies could improve outcomes for people with MS

New findings by researchers at Cardiff University suggest that intensive therapy during the early stages of MS can lead to better long-term outcomes. This is despite it often being viewed as a riskier option than other first line treatments.

Early intensive DMTs vs milder DMTs

We’ve seen huge advances in the treatment options available for people with relapsing MS over the last 20 years. But there’s still uncertainty about whether to treat MS with intensive treatments from the beginning - or start with milder treatments and only escalate to more intensive treatments when the less effective DMTs have failed.

In this study, which we've funded, Professor Neil Robertson's team looked at data from 592 people with MS. They had all had been treated in south Wales over the last 20 years. Using the Expanded Disability Status Scale (EDSS), the team looked at the progression of disability five years after starting treatment.

Dr Emma Tallantyre, co-author of the study, said: “We found that in this cohort, long-term outcomes were more favourable following early intensive therapy versus first-line disease modifying therapies.”

People who started treatment with the more aggressive DMTs showed an average increase in EDSS of 0.3 over 5 years. This is compared to an increase of 1.2 in those who began on milder treatments and escalated to more intensive treatments over time.

This suggests that starting treatment with more aggressive DMTs, like Lemtrada and Tysabri, leads to better outcomes for people with MS than less aggressive DMTs, such as the beta interferons, Copaxone and Tecfidera.

“A game changer” for MS research

Our Director of Research Dr Susan Kohlhaas said: “People with MS regularly tell us that treatment decisions are difficult to make. This study could be a game changer because it suggests people who have early intensive treatment have a better long term prognosis. We’re driving research into more and better therapies, and are proud to have funded this work.”

Exciting next steps

Professor Neil Robertson, co-author of the study, said, “This data shows that in a very complex therapeutic landscape, routine data collected in NHS clinics has huge value in providing real-world evidence that can help to answer the questions that are important to patients.”

This retrospective data gives us an insight into the benefits of an intensive approach to treatment. The next step will be to complete a randomised clinical trial, called DELIVER-MS, which will fully compare the two approaches to treatment and the risks and benefits associated with them. Dr Susan Kohlhaas said: “Once complete we hope this could have really positive implications for people with MS.”

Professor Neil Robertson added: “In the meantime, there is work to be done in developing adequate procedures for treating patients using the escalation approach. These need to detect where first-line treatments are failing to slow the progression of the disease and respond by moving patients to more effective therapies without people developing permanent disability.”  

You can read the study in full on the JAMA Network website.