Vall d'Hebron shows that starting medication in patients with first symptoms of multiple sclerosis reduces long-term disability

Starting treatment for multiple sclerosis less than six months after the onset of the first symptoms reduces the risk of disability as the disease progresses. These results are demonstrated by a study led by the Vall d'Hebron Research Institute (VHIR) and the Multiple Sclerosis Center of Catalonia (Cemcat), part of the Vall d’Hebron Campus, published in Neurology.

In multiple sclerosis, the patients' immune system attacks myelin, a substance that insulates and protects the nerves. Although the most common symptoms are related to mobility or balance problems, the disease includes other symptoms such as fatigue, tingling in the extremities, vision difficulties, neurological alterations, among others. The progression of the disease can be very diverse depending on each patient, but until now very little is known about these differences, which is why research is essential to anticipate severe symptoms and improve the quality of life of patients.

The work presented now consisted of the follow-up of 580 people between 16 and 50 years of age who had a first episode of symptoms related to multiple sclerosis and were treated at Cemcat between 1994 and 2021. All of them were taking a drug to control the inflammatory process characteristic of the disease, but they had started receiving it at different times: 194 had started treatment less than six months after the first episode, 192 patients had started it between six and 16 months after the onset of symptoms, and 194 more than 16 months later.

The researchers monitored patients' disability and magnetic resonance imaging for an average of 11 years. It was found that people who had received treatment in the first six months after the onset of the first symptoms had half the risk of having advanced disability compared to those who had started treatment more than 16 months later. For example, they had more mobility and strength in their limbs, less sleep disturbance, less fatigue and anxiety, and better cognitive function.

On the other hand, it was observed that, in people with early therapy, the disease remained stable for longer than in those who had received it 16 months later. In addition, patients with early treatment had a 60% lower risk of progressing to secondary progressive multiple sclerosis, in which symptoms worsen steadily, and not only when there are flare-ups. Specifically, 7% of patients who received therapy before six months made this progression, while this number increased to 23% in patients who did so more than 16 months later. 

"Our results are the first to show that, when symptoms begin to show, the sooner we start treatment, the better, even before the definitive diagnosis of multiple sclerosis", explains Dr. Alvaro Cobo-Calvo, neurologist at the Neurology Department of the Vall d'Hebron University Hospital and Cemcat, principal investigator of the Clinical Neuroimmunology group at VHIR and first author of the study. "In this way, the progression will be slower and the disability that patients suffer years later will decrease. For this, it is also essential to promote early detection of multiple sclerosis", he adds.

Magnetic resonance imaging aids in the follow-up of patients with multiple sclerosis

The research also reaffirms the importance of MRI in the follow-up of patients with multiple sclerosis. The results show that the information provided by resonance imaging is essential in helping healthcare professionals make decisions to initiate treatment earlier and subsequently evaluate the response to therapies.7

"Radiological images indicate that, even when the patient has from the beginning important lesions in the nervous system, often accompanied by severe symptoms, early treatment is able to stop the progression of the disease", concludes Dr. Xavier Montalban, head of the Neurology Department at Vall d'Hebron University Hospital, head of the Clinical Neuroimmunology research group at VHIR and director of Cemcat.