Initial treatment choice for multiple sclerosis and prognosis at year 3 are associated with few poor prognosis factors

Introduction Predicting the clinical outcomes of patients with multiple sclerosis (MS) is important at onset, depending on multiple prognostic factors. The early choice of high efficacy treatment is only driven by some of these factors, mainly the frequency of attacks. We examined the combined effect of all the predictive elements associated with poor outcomes at year 3, in relation with the choice of first-line disease-modifying therapies or high-efficacy DMT (fl-DMT or he-DMT). Objective To analyze the influence of poor prognosis risk factors on clinical outcomes. Methods Clinical data, imaging data, cerebrospinal fluid (CSF) data, and therapies were retrospectively analyzed in large monocentric series of patients with relapsing-remitting MS. The primary and secondary outcomes were the risk of reaching ≥+1 point EDSS or ≥1 relapse at year 3, respectively. Results he-DMT was first initiated in 25.1% of patients (44/175). The primary outcome (impairment) was observed in 41.7% of the patients and associated with younger age, EDSS≥3, and multiple clinical involvement at the first attack. Multivariate modelling confirmed the strong influence of age, baseline impairment, and he-DMT. The secondary outcome (relapse) occurred in 55.4% of patients and was associated with younger age, CSF white cell count, and absence of early he-DMT. Conclusions Delayed high-efficacy therapy was a major negative factor, followed by younger age, EDSS≥3 at onset, and abnormal CSF white cells. Some factors might be active very early in MS history and could be mitigated by early he-DMT initiation.