Delay from treatment start to full effect of immunotherapies for multiple sclerosis

Izanne Roos, E. Leray, F. Frascoli, R. Casey, J. William, L. Brown, D. Horakova, E. K. Havrdova, M. Trojano, F. Patti, G. Izquierdo, S. Eichau, M. Onofrj, A. Lugaresi, A. Prat, M. Girard, P. Grammond, P. Sola, D. Ferraro, S. Ozakbas, R. Bergamaschi, M. Jose´Sa´, E. Cartechini, C. Boz, F. Granella, R. Hupperts, M. Terzi, J. Lechner-Scott, D. Spitaleri, V. Van Pesch, A. Soysal, J. Olascoaga, J. Prevost, E. Aguera-Morales, M. Slee, T. Csepany, R. Turkoglu, Y. Sidhom, R. Gouider, B. Van Wijmeersch, P. McCombe, R. Macdonell, A. Coles, C. B. Malpas,  H. Butzkueven, S. Vukusic and T. Kalincik on behalf of the MSBase and OFSEP investigators

doi:10.1093/brain/awaa231

Selezionato dal Lettore: Renato Simonetti - Azienda Ospedaliero-Universitaria di Ferrara

Motivation: This is an observational longitudinal study that considers clinical and demographic data from 125 centres in 37 countries extracted from the MSBase registry in November 2018 and from 39 French centres in the OFSEP cohort in December 2018. Data quality was controlled through a previously published data verification process (Kalinciket al.,2017). The use of two differing sources of data (MSBase, a global registry of self-selected predominantly academic multiple sclerosis centres, and OFSEP, a national cohort from academic multiple sclerosis centres) helps further mitigate the effects of selection and reporting biases. Presentation of data and results is clear; it defines the therapeutic lag with respect to two principal clinical presentations of multiple sclerosis (relapses and progression-of-disability) for the most commonly used immunotherapies, concluding that full effect of treatment on relapses is reached within 12–30weeks after commencing therapy, whilst the full effect on disability progression is reached within 30–70 weeks.

The aim of the study is to define accurately the therapeutic lag (intended as the delay from starting a therapy to reach its full clinical effect) needed, that is highly relevant to decisions regarding the use of MS therapies, in particular during the early weeks after the commencement of therapy; with this in mind, it could act as a guideline for the patients and the Neurologists engaged in the treatment of multiple sclerosis.