Early treatment in multiple sclerosis

SummaryThere is now a consensus that early treatment of patients with relapsing–remitting multiple sclerosis is desirable, mainly because early treatment may delay the accumulation of disability, but also because disease-modifying treatments seem to be more effective when started early in the course of the disease. In particular, all current first-line disease-modifying treatments have also been shown to be effective in treating clinically isolated syndrome. The evidence for this comes from extensive experience in randomised controlled Phase III clinical trials. While many patients presenting a clinically isolated syndrome are at high risk of experiencing a second attack, early treatment with all disease-modifying treatments has been shown to delay conversion to clinically definite multiple sclerosis when compared to late treatment. Some of these trials have completed five years of follow-up. While the evidence for early intervention is stronger than ever, it is worthwhile to consider its relevance to everyday clinical practice. In particular, it is important to determine which patients are the best candidates for early therapy and to evaluate the anticipated risks and benefits of choosing a given therapy for a given patient.