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Optimizing Treatment of Relapsing-Remitting Multiple Sclerosis with Oral Therapies - Episode 2

Importance of Early Treatment Start in MS

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

Ahmed Zayed Obeidat, MD, PhD: 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?

Annette Okai, MD, FAAN: 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.

Ahmed Zayed Obeidat, MD, PhD: 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.

Transcript Edited for Clarity