title: Importance of early treatment initiation in the clinical course of multiple sclerosis.
abstract: OBJECTIVE
  The aim of this study was to identify factors influencing the long-term clinical progression of multiple sclerosis (MS). A special objective was to investigate whether early treatment decisions influence outcome.
  
  
  METHODS
  We included 639 patients diagnosed with MS from 2001 to 2007. The median follow-up time was 99 months (8.25 years). Cox regression models were applied to identify factors correlating with the outcome variable defined as time from treatment start to irreversible score 4 of the Expanded Disability Status Scale (EDSS).
  
  
  RESULTS
  Patients initiated on treatment later had a greater risk of reaching EDSS 4 (hazard ratio of 1.074 (95% confidence interval (CI), 1.048-1.101)), increased by 7.4% for every year of delay in treatment start after MS onset. Patients who started treatment after 3 years from MS onset reached the outcome sooner with hazard ratio of 2.64 (95% CI, 1.71-4.08) compared with the patients who started treatment within 1 year from MS onset. Baseline EDSS and age at onset were found to be predictive factors of disability progression.
  
  
  CONCLUSIONS
  Early treatment initiation was associated with a better clinical outcome. In addition, we confirmed the well-established prognostic factors of late age at onset and early disability.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Andrius
authors.initials: A
authors.lastname: Kavaliunas
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ali
authors.initials: A
authors.lastname: Manouchehrinia
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Leszek
authors.initials: L
authors.lastname: Stawiarz
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Mathematics, KTH Royal Institute of Technology, Stockholm, Sweden.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ramanujam
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Agholme
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna Karin
authors.initials: AK
authors.lastname: Hedström
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Kermanshah University of Medical Sciences, Kermanshah, Iran.
authors.forename: Omid
authors.initials: O
authors.lastname: Beiki
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Glaser
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Hillert
mesh_terms: D000368:Aged; D018450:Disease Progression; D061345:Early Medical Intervention; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
keywords: Multiple sclerosis; cohort studies; disability evaluation; disease progression; drug therapy; survival analysis; treatment outcome