The cost of delaying treatment in multiple sclerosis

To the Editor: I enthusiastically agree with the conclusion reached by Drs. Schwid and Bever: “that foregoing MS treatment, even for only 2 years, has consequences that may never be reversed.”1 We are fortunate to have two classifications of drugs that have proven that statement—glatiramer acetate and IFN-β. Evidence suggests that delaying treatment with either drug is deleterious to our patients. The 6-year results of Copaxone use presented earlier this year at the American Academy of Neurology meeting in Philadelphia showed a similar effect of delayed treatment.2 In patients taking Copaxone from the start of the trial, only 31% had increased disability, whereas 43% of those whose treatment was delayed by approximately 30 months had increased disability after 6 years ( p = 0.06). In addition, examination of the Kaplan–Meier curves of the probability of Extended Disability Status Scale (EDSS) worsening at 1.5 or more shows that the treatment groups do not converge even after 6 years of treatment. As a group, the patients whose Copaxone treatment was delayed by 30 months never achieved the same level of disability stabilization as the patients who received Copaxone from the beginning of the trial. The winners in these studies are our patients who have self-injected up to 6 years in each of these studies. My hat is off to them. I truly believe we are altering the course of their disease. I heartily congratulate the researchers and examiners of both the PRISMS-4 study …