The Importance of Long-Term Treatment
Presently, the 10 FDA-approved disease-modifying therapies (DMTs) are only available for individuals with relapsing forms of multiple sclerosis – largely for those with RRMS. Research (including many clinical trials) is ongoing at a rigorous pace to find treatments that will also be effective for the progressive forms of MS. Fortunately, symptom-management strategies and comprehensive care plans with teams of doctors, nurses, and therapists, help to greatly improve the quality of life for all individuals with MS – both with relapsing and progressive forms of MS.
Treatment with a long-term DMT is crucial for most patients with relapsing forms of MS, since disease activity and damage usually continue within the CNS even when no new symptoms are present. When a patient begins a treatment regimen early in his or her disease course, disease activity is slowed for most individuals. This not only reduces the number and severity of symptom flare-ups, as well as delays the progression of the disease (and possibly delays any related disability), but also reduces the number of active lesions that appear on an MRI.
Additionally, a 21-year prospective study of individuals (with RRMS) who began therapy early in the disease found that they experienced a longer lifespan than those who did not begin treatment as early. This study was conducted with a specific DMT; more studies are needed to see if the same is true for all DMTs.
Getting early treatment and staying on one of the DMTs for MS may also delay the rate of conversion from RRMS to secondary-progressive MS (SPMS). This latter form of MS that follows RRMS exhibits a steady worsening, with or without relapses. If flare-ups do occur, they usually do not remit fully. As mentioned earlier, without treatment, about half of individuals with RRMS convert to SPMS within 10 years. However, since the introduction of the first treatment in 1993, those taking a DMT have reduced or delayed the conversion to SPMS.