Clinical, laboratory and imaging features of patients with relapsing remitting multiple sclerosis or clinically isolated syndrome at the time of decision to start disease modifying treatment

Abstract

The study investigated the factors considered by physicians in order to choose a disease-modifying treatment
for patients with a) relapsing-remitting multiple sclerosis, or b) a single demyelinating event having high
risk for clinically definite disease. The retrospective analysis of 226 patients showed evidence: at least
one lesion in the brain reported with MRI (mean number of lesions in the brain: 1.5 and 1.7 respectively),
satisfying the criteria Barkhof-Tintoré (97,9% and 97 , 5% respectively), and multifocal form of the last
episode (60.3% and 65% respectively). The majority of patients had oligoclonal bands in the cerebrospinal
fluid (CSF) (66.2% and 78.8% respectively), and were in the early stages of the disease based on the EDSS
rating scale (3.7 and 3.9 respectively). Almost all patients with relapsing-remitting disease were positive
according to McDonald criteria (91.5%). Most patients (84.7% and 84%) received corticosteroids to treat
acute episode. Patients with relapsing-remitting disease were treated with α disease-modifying factor after
three episodes were preceded –which in approximately half of the population (median) were apart by six
months. Treatment of first choice was interferon beta, in all its forms (83.4% and 92.6% respectively).
Very low preference was noted for glatiramer acetate (7.6% and 7.4% respectively) and natalizumab
(9% and 0%, respectively). Preference for the 1b subcutaneous injected form of interferon was recorded
for the majority (54.3%) of patients with a clinically isolated syndrome. The study showed that the main
factors influencing the decision for a disease-modifying treatment are the findings of magnetic resonance
imaging, detection of oligoclonal bands in CSF, and the multifocal form of the episode. The choice for this
treatment is usually done early in disease progression, suggesting that in clinical practice the benefits of
early initiation of treatment with disease modifying factors are positively assessed. There is however a need
for greater vigilance and inform attending physicians on the positive effect of early treatment with disease
modifying factors on development of multiple sclerosis.