Early treatment delays long-term disability accrual in RRMS: Results from the BMSD network

Pietro Iaffaldano, Giuseppe Lucisano, Helmut Butzkueven, Jan Hillert, Robert Hyde, Nils Koch-Henriksen, Melinda Magyari, Fabio Pellegrini, Tim Spelman, Per Soelberg Sørensen, Sandra Vukusic, Maria Trojano

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35 Citations (Scopus)


Background: The optimal timing of treatment starts for achieving the best control on the long-term disability accumulation in multiple sclerosis (MS) is still to be defined. Objective: The aim of this study was to estimate the optimal time to start disease-modifying therapies (DMTs) to prevent the long-term disability accumulation in MS, using a pooled dataset from the Big Multiple Sclerosis Data (BMSD) network. Methods: Multivariable Cox regression models adjusted for the time to first treatment start from disease onset (in quintiles) were used. To mitigate the impact of potential biases, a set of pairwise propensity score (PS)-matched analyses were performed. The first quintile, including patients treated within 1.2 years from onset, was used as reference. Results: A cohort of 11,871 patients (median follow-up after treatment start: 13.2 years) was analyzed. A 3- and 12-month confirmed disability worsening event and irreversible Expanded Disability Status Scale (EDSS) 4.0 and 6.0 scores were reached by 7062 (59.5%), 4138 (34.9%), 3209 (31.1%), and 1909 (16.5%) patients, respectively. The risk of reaching all the disability outcomes was significantly lower (p < 0.0004) for the first quintile patients’ group. Conclusion: Real-world data from the BMSD demonstrate that DMTs should be commenced within 1.2 years from the disease onset to reduce the risk of disability accumulation over the long term.

Original languageEnglish
Pages (from-to)1543-1555
Number of pages13
JournalMultiple Sclerosis Journal
Issue number10
Publication statusPublished - Sept 2021


  • big data
  • early treatment
  • EDSS
  • Multiple sclerosis

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