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Summary
There is now a consensus that early treatment of patients with relapsing–remitting
multiple sclerosis is desirable, mainly because early treatment may delay the accumulation
of disability, but also because disease-modifying treatments seem to be more effective
when started early in the course of the disease. In particular, all current first-line
disease-modifying treatments have also been shown to be effective in treating clinically
isolated syndrome. The evidence for this comes from extensive experience in randomised
controlled Phase III clinical trials. While many patients presenting a clinically
isolated syndrome are at high risk of experiencing a second attack, early treatment
with all disease-modifying treatments has been shown to delay conversion to clinically
definite multiple sclerosis when compared to late treatment. Some of these trials
have completed five years of follow-up. While the evidence for early intervention
is stronger than ever, it is worthwhile to consider its relevance to everyday clinical
practice. In particular, it is important to determine which patients are the best
candidates for early therapy and to evaluate the anticipated risks and benefits of
choosing a given therapy for a given patient.
Keywords
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© 2011 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
