Annette Okai, MD, FAAN

 I’ll transition to treatment. We’re going to focus mostly on treatment of relapsing-remitting multiple sclerosis. I want to share a little about when we diagnose multiple sclerosis [MS]. It’s a process; we don’t have a single test. It’s a combination of clinical, radiological, and laboratory testing. When we reach a diagnosis, a question that comes up is, “When do we start treatment for relapsing-remitting MS?” Sometimes in a clinic, people come to me and say, “I don’t have any symptoms. I recovered. You gave me some treatment. Do I really need to start treatment for MS? Can I wait?” This is a real question that comes up in clinic. I’m curious, for our audience, if you can share with us when should we start treatment for relapsing-remitting MS?

I also get that question when the patient has recovered from the relapse and they have no further symptoms. They think, “Can I wait?” But I’d like to use the phrase “time is brain.” It’s the phrase that covers a lot of neurological disorders, but MS especially. MS is a disease of the young, and MS is very debilitating if not treated early on. Knowing about this disease over the years from studying it, we’ve concluded that the earlier you treat, the better it is for the patient in the present and in the long term. Even though the patient is reporting no symptoms clinically, there may still be MRI activity. Any MRI activity can lead to irreversible loss of brain tissue that we may not be able to get back if we don’t take action early on. Several studies have shown that the earlier you treat patients, the more advantage you’re giving them in the long term. You’re saving their brain tissue and reducing the risk of disability. I advocate for treating as early as possible, as soon as we can get medications approved, to start treatment for the patient regardless of whether they’re experiencing symptoms.

 Thank you very much. This is a very important topic. It’s a very practical topic because we know from natural history studies that the early treatment is going to affect the long-term outcome of multiple sclerosis. Also, we invest in treatment now because the earlier we can treat MS, the better we can control the disease. As you mentioned, MRI activity can still be happening without overt symptoms, and people still accumulate neuron damage because of being untreated for multiple sclerosis.

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Dr Okai explains why it is important to initiate MS treatment early and to stay compliant with the treatment.

Importance of Early Treatment Start in MS

 presentation titled “Optimizing Treatment of Relapsing-Remitting Multiple Sclerosis With Oral Therapies.” I’m Dr Ahmed Zayed Obeidat, from the Medical College of Wisconsin [in Milwaukee]. Joining me is Dr Annette Okai, from the North Texas Institute of Neurology & Headache in Plano. Today we’re going to discuss the use of oral therapies in the treatment of relapsing-remitting multiple sclerosis. We’ll share long-term and real-world data that were recently presented at ACTRIMS [Americas Committee for Treatment and Research in Multiple Sclerosis] in 2022 and how recent and emerging therapeutics advances have and are likely to change the care of people living with multiple sclerosis [MS]. Thank you so much for joining us. Let’s begin.

Dr Okai, it’s great to see you today and to have you here to discuss a very important topic related to multiple sclerosis. First, as we know, multiple sclerosis prevalence is increasing, but we think the numbers are more than it was before. Maybe it’s related to the diagnostic ability, but it might be related to an actual increase in the prevalence of MS. What I want to discuss with you very briefly is the prevalence, presentation, and diagnosis of relapsing-remitting multiple sclerosis.

Thank you so much for having me. It’s a pleasure to talk to you. I’m glad to speak on this topic, which is very dear to both of our hearts. As you mentioned, the prevalence of multiple sclerosis is increasing, and there are a number of explanations. One is that we’re diagnosing earlier than we did in the past. The diagnostic criteria have made it easier to make the diagnosis, so those we considered early or not clinically definite before are now being put in the category of multiple sclerosis. As you said, it could be that there’s a genuine increase in the incidence and prevalence of the disease. There are several factors that contribute to this and that need to be looked into further. But whatever the explanation, it has been shown that we have an increase in the disease. With the increase, we need more specialists to take care of these people. We need people who are taking care of people with MS to also understand that it’s important to make an accurate diagnosis, make it early, and implement treatment early on.

This is great. Thank you for this brief but great explanation of the topic. One other thing you mentioned is the impact of MS on not only patients but also caregivers and loved ones. Can you please elaborate a little on the impact of relapsing multiple sclerosis on the quality of life of patients and their caregivers?

Absolutely. Relapsing MS is aptly titled. It’s characterized by relapses, and relapses can vary in intensity and severity. It can be as severe as affecting daily function of life so that people may need assistance from caregivers. It can be debilitating, requiring 24-hour assistance. Thankfully, medications have reduced that severity, but it still occurs. For those taking care of patients with relapsing MS, and with the debilitation it brings, it also wears on them. We have to consider not only the patient and the impact of taking away their independence but also the toll it takes on the person caring for that person. When you’re looking at a patient with MS, you have to look at the patient as a whole and how the environment they’re in affects them. That also affects, in a way, their disease progress. Looking at the patient and the caregiver is important in taking care of the whole patient.

These are valuable points. We see the patient and the caregiver— or even multiple caregivers for 1 patient—but sometimes we forget about the impact of the disease on both, so this is something of immense importance. Thanks for sharing this with our audience.

Drs Obeidat and Okai, 2 MS experts, discuss impact of relapsing-remitting multiple sclerosis (RRMS) on the quality of life of patients and caregivers.

Annette Okai, MD, FAAN

Articles

Importance of Early Treatment Start in MS

Relapsing-Remitting Multiple Sclerosis (RRMS) and Impact on Quality of Life

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