title: Influence of treatments in multiple sclerosis disability: a cohort study.
abstract: OBJECTIVE
  A critical aspect of multiple sclerosis (MS) treatments is understanding the effect of disease-modifying drugs (DMDs) on the long-term risk of disability and whether the effect is related to disability at start of treatment.
  
  
  METHODS
  We performed an observational study on 3060 MS patients. The effect of therapy on progression to Expanded Disability Status Scale (EDSS) 3.0 and 6.0 from onset was analysed in treated vs untreated (UTP) patients using Cox regression analysis adjusted for propensity score and immortal time bias.
  
  
  RESULTS
  Compared to UTP, the risks of EDSS 3.0 were 94% and 73% lower in immunomodulant (IMTP-) and immunosuppressant (ISTP-) treated patients, respectively, while the risk of EDSS 6.0 was 86% lower in IMTP. The risk of EDSS 6.0 was, respectively, 91% and 75% lower in 1275 IMTP before and 114 after EDSS 3.0 than in 539 UTP; the risk was higher in IMTP starting therapy after EDSS 3.0 than before (HR = 4.42).
  
  
  CONCLUSIONS
  DMDs delayed long-term disability in MS patients treated either in the early or, to a lesser extent, in the later phase of the disease. Thus, the window of therapeutic opportunity is relatively extended, assuming that early is better than late treatment, but late is better than never.
authors.affiliation: Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Cocco
authors.affiliation: University of Cagliari, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Sardu
authors.affiliation: MS Center, ASL 8, Cagliari, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Spinicci
authors.affiliation: MS Center, ASL 8, Cagliari, Italy.
authors.forename: Luigina
authors.initials: L
authors.lastname: Musu
authors.affiliation: MS Center, ASL 8, Cagliari, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Massa
authors.affiliation: Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Frau
authors.affiliation: Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy.
authors.forename: Lorena
authors.initials: L
authors.lastname: Lorefice
authors.affiliation: Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fenu
authors.affiliation: Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Coghe
authors.affiliation: MS Center, ASL 8, Cagliari, Italy.
authors.forename: Serenella
authors.initials: S
authors.lastname: Massole
authors.affiliation: MS Center, ASL 8, Cagliari, Italy.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Maioli
authors.affiliation: Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy.
authors.forename: Rachele
authors.initials: R
authors.lastname: Piras
authors.affiliation: Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Melis
authors.affiliation: MS Center, ASL 8, Cagliari, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Porcu
authors.affiliation: MS Center, ASL 8, Cagliari, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Mamusa
authors.affiliation: MS Center, ASL 8, Cagliari, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Carboni
authors.affiliation: University of Cagliari, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Contu
authors.affiliation: Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy gmarrosu@unica.it.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Marrosu
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D016016:Proportional Hazards Models
chemical_list: D007155:Immunologic Factors; D007166:Immunosuppressive Agents
keywords: Multiple sclerosis; disability; immunomodulant; immunosuppressant; treatment