People with clinically isolated syndrome (CIS) never treated with DMDs do best

An intriguing study from Austria has come up with an unexpected finding. The study examined 163 people with a new diagnosis of clinically isoloated syndrome (CIS) suggestive of MS attending 29 MS clinics in Austria.

They were looking at whether and when standard disease-modifying drugs (DMDs), the interferons and glatiramer, were started for these people, why they were started, and how the people progressed over the next two years of follow up. Generally, most authorities recommend starting DMDs as soon as possible after a CIS to prevent progression to MS, although it has not been known how often this is done in practice. The decision to treat was made by the treating neurologist, in discussion with the patient.

The findings were intriguing. Around a third of patients were treated immediately, a third after three months, and a third not at all. Of those treated immediately, 36% went on to develop definite MS, of those treated later 56% developed MS, and of those never treated only 19% developed MS. The immediately treated group had an average of 0.5 relapses per year during the study, the later treated group had 1.0 relapses per year, and the never treated group only 0.2 relapses per year. These differences were highly statistically significant. The treated patients also had worse EDSS (disability) scores at two years than the never treated group. While these differences to some extent reflect the fact that the people with CIS who were thought by the neurologists to have more severe disease (with more lesions on MRI, etc) were more likely to be put on DMDs early, the findings are hardly compelling evidence of the need for early institution of DMDs for people with a CIS suggestive of MS. While physicians often argue that patients are taking a grave risk by not taking DMDs early, these data suggest that many patients do extremely well without any medication.

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