A/Prof Ingrid van der Mei

People with progressive-onset MS are worse off in terms of almost all symptoms and levels of disability than people with relapse-onset MS, an Australian study based on patient reported outcomes has found.

And the disparities in severity of MS are especially pronounced in early stages of the disease, according to findings from 1985 participants in the Australian Multiple Sclerosis Longitudinal Study (AMSLS).

Researchers at the Menzies Institute for Medical Research, University of Tasmania, said their findings highlighted the need to focus on early intervention for people with progressive-onset MS and the need for symptomatic treatments.

Study authors Dr Yan Zhang and Associate Professor Ingrid van der Mei said progressive-onset MS was less well understood than relapse-onset MS because it accounted for a relatively low proportion (12%) of MS cases and therefore studies lacked numbers and analytical power.

In their study, they analysed responses to a 2015 survey of AMSLS participants and found the severity of 17 or 19 patient reported outcomes was significantly higher for progressive-onset MS than relapse-onset MS.

Even after adjusting for confounding factors such as later onset of disease, patient reported outcomes were still significantly worse for measures of disability, progression over the last year, walking difficulties, bladder problems and spasticity.

For example, the severity of walking difficulties was 50% higher for people with progressive-onset MS compared to people with relapse-onset MS.

“The differences between the two onset types was most pronounced early in the disease process and reduced with increasing MS duration,” they noted.

Writing in the European Journal of Neurology, they said the study was the first to compare  progressive-onset MS and relapse-onset MS symptoms and disability in a large group of patients, using patient reported outcomes.

They said the results showed the need for early intervention in progressive MS patients, and for clinical trials to have a specific focus on early MS, “as gain could be made by earlier intervention to reduce the total burden of progressive MS.”

“Our findings [also] show that the work should not only focus on disease-modifying treatments, but also on symptomatic management,” they added

A focus on early interventions would aligns with the use of immunotherapy treatments in people with relapse-onset MS, where it has been shown that early treatment seems to substantially benefit outcomes compared to delayed treatment, the researchers said.