Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Apr:39:101908.
doi: 10.1016/j.msard.2019.101908. Epub 2019 Dec 23.

To treat or not to treat: Sequential individualized treatment evaluation in relapsing multiple sclerosis

Gabriel Bsteh  1 , Harald Hegen  2 , Carolin Dosser  2 , Michael Auer  2 , Klaus Berek  2 , Sebastian Wurth  2 , Anne Zinganell  2 , Franziska Di Pauli  2 , Florian Deisenhammer  2 , Thomas Berger  3
Affiliations

To treat or not to treat: Sequential individualized treatment evaluation in relapsing multiple sclerosis

Gabriel Bsteh et al. Mult Scler Relat Disord. 2020 Apr.

Abstract

Background: The frequency and long-term prognosis of relapsing multiple sclerosis (RMS) never receiving disease-modifying treatment (DMT) is unclear.

Methods: We included 1186 RMS patients with a mean of 17.4 years follow-up and divided them into patients treated with any DMT (DMT) and patients untreated by shared (USD) or patient-autonomous decision (UAD).

Results: The USD group displayed features, which significantly differed from the two other groups: higher age at onset, mainly sensory onset symptoms, complete remission of onset symptoms, less T2 and contrast-enhancing T1 lesions on initial brain MRI. In a multivariate cox regression, USD was associated with lower risk for secondary progression (SPMS) conversion (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.55-0.97, p = 0.011) compared to DMT, while UAD was associated with an increased SPMS conversion risk only in the "McDonald era" (HR 1.19, CI 1.02-1.58, p = 0.028).

Conclusion: Apart from the doubtless substantial improvement of the overall prognosis of RMS by DMT, it seems likely that not every patient necessarily needs immediate or even "hard and early" treatment. A "watchful waiting" approach with continuous clinical evaluation might be instead a viable option in RMS patients with favorable prognostic features at onset.

Keywords: Disease modifying treatment; Long-term; Multiple sclerosis; Prognosis; Untreated.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest Gabriel Bsteh: has participated in meetings sponsored by, received speaker honoraria or travel funding from Biogen, Celgene, Merck, Novartis, Sanofi-Genzyme and Teva, and received honoraria for consulting Biogen, Roche and Teva. Carolin Dosser: declares no conflicts of interest. Harald Hegen: has participated in meetings sponsored by, received speaker honoraria or travel funding from Bayer, Biogen, Merck, Novartis, Sanofi-Genzyme, Siemens and Teva, and received honoraria for consulting Teva. Klaus Berek: declares no conflicts of interest. Michael Auer: received speaker honoraria and/or travel grants from Biogen, Merck and Novartis. Sebastian Wurth: has participated in meetings sponsored by, received honoraria or travel funding from Allergan, Biogen, Ipsen Pharma, Merck, Novartis, Roche, Sanofi Genzyme and Teva. Anne Zinganell: has participated in meetings sponsored by, received speaking honoraria or travel funding from Biogen, Merck, Sanofi-Genzyme and Teva. Franziska Di Pauli: has received speaking honoraria from Biogen and Sanofi-Genzyme. Florian Deisenhammer: has participated in meetings sponsored by or received honoraria for acting as an advisor/speaker for Bayer, Biogen, Merck, Novartis, Roche and Sanofi-Genzyme. Thomas Berger: has participated in meetings sponsored by and received honoraria (lectures, advisory boards, consultations) from pharmaceutical companies marketing treatments for MS: Allergan, Bayer, Biogen, Bionorica, Celgene, MedDay, Merck, Novartis, Octapharma, Roche, Sanofi-Genzyme, Teva. His institution has received financial support in the past 12 months by unrestricted research grants (Biogen, Bayer, Merck, Novartis, Sanofi Aventis, Teva and for participation in clinical trials in multiple sclerosis sponsored by Alexion, Bayer, Biogen, Merck, Novartis, Octapharma, Roche, Sanofi-Genzyme, Teva.

Comment in

LinkOut - more resources