Early Initiation of Therapy for RRMS


The rationale for early treatment initiation for patients with relapsing-remitting multiple sclerosis.

Jennifer Graves, MD, PhD, MAS: Let’s talk about the concept of treating earlier. Our stroke colleagues use the phrase “Time is brain,” and we’re starting to hear more MS [multiple sclerosis] doctors use the same phrase. What’s the importance of brain preservation in your approach in early treatment of MS?

Suma Shah, MD: That conversation is important to have early. I often tell folks that our understanding of MS has changed over time. It’s not just the relapses that we know to look for and can find on MRIs but the idea of cerebral reserve. The fact is that all of us have aging brains. I mention this to all my patients. If you have brains with lesions on top of that from inflammatory disease, then that’s only going to make it harder to age gracefully. That tends to land very well with my patients.

Gabrielle Macaron, MD: It’s important for patients to understand that the natural evolution of MS is marked by accumulation of inflammatory yet demyelinating lesions, and that within those lesions there’s axonal transaction, and this will lead further down the line to neurodegeneration. There’s the concept of whole-brain atrophy, which starts early. Then the rate continues to increase over time, smoldering lesions, the axonal injury that we can’t see on MRI that’s present in even normal-appearing gray and white matter—all these things contribute to disability in the long run and worst outcome. Maybe we’re not going to use these words with patients, but it’s important for them to understand that letting brain damage happen early means we’re going to have problems in the long run. In other words, we need to treat those patients early too, because it’s directly linked to this concept. It’s a key in central nervous system preservation.

Jennifer Graves, MD, PhD, MAS: Thank you for watching this Neurology Live® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your in-box.

Transcript edited for clarity.

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