About this Video

• Video Title: Multiple Sclerosis Treated Early and Aggressively
• Channel: Dr. Brandon Beaber
• Speakers: Dr. Brandon Beaber
• Duration: 00:13:48

Introduction

This video discusses a French study analyzing the long-term effects of starting highly effective disease-modifying therapies (DMTs) early in the course of multiple sclerosis (MS). The speaker examines the study's findings on the development of secondary progressive MS (SPMS) and identifies predictors of this progression.

Key Takeaways

• A French study analyzed a database of MS patients who began highly active DMTs within 5 years of MS onset. After 10 years, only 8% developed secondary progressive MS (SPMS), a surprisingly low rate.
• Predictors of SPMS included older age at treatment initiation, higher number of relapses before and after starting treatment, and higher baseline disability. Women showed a reduced risk compared to men.
• Relapse-associated worsening (RAW), increased disability directly linked to a relapse, was a significant predictor of SPMS.
• Progression independent of relapse activity (PIRA) and progression independent of all activity (PIA) were also examined and correlated with SPMS development. Those without PIA had virtually no risk of SPMS.
• The study suggests that early, aggressive treatment with highly active DMTs in individuals with relapsing-remitting MS and low initial disability may lead to a favorable long-term prognosis, although longer follow-up is needed for confirmation.

Based on the provided transcript, here are the definitions of the acronyms used:

• MS: Multiple Sclerosis
• DMT: Disease-Modifying Therapy
• SPMS: Secondary Progressive Multiple Sclerosis
• EDSS: Expanded Disability Status Scale
• MRI: Magnetic Resonance Imaging
• RAW: Relapse-Associated Worsening
• PIRA: Progression Independent of Relapse Activity
• PIA: Progression Independent of All Activity

The take-home message is that early and aggressive treatment of relapsing-remitting multiple sclerosis (MS) with highly active disease-modifying therapies (DMTs) in patients with low initial disability and younger age may significantly reduce the risk of transitioning to secondary progressive MS (SPMS) over a 10-year period. However, the presence of relapses (both before and after treatment), and higher baseline disability levels are significant predictors of SPMS development, even with early and aggressive treatment. Longer-term studies are needed to confirm these findings.