Multiple sclerosis drugs have been proved to reduce relapses. But some with MS still say no to treatment.
In many chronic conditions, the way the disease will progress over months or years is relatively predictable. That’s not the case with multiple sclerosis (MS); while some people with the disease may be only mildly impacted over years or even decades, others may lose their ability to walk, speak, or swallow over time. And many are affected cognitively, meaning their ability to think, focus, and remember may be impaired, making it difficult to hold down a job.
Because the course of MS can vary dramatically from person to person, it’s hard to know with absolute certainty what the prognosis will be for an individual who doesn’t get treatment. But that lack of predictability doesn’t mean a “wait and see” approach is a good idea, says Justin Abbatemarco, MD, a neurologist at the Cleveland Clinic who specializes in treating multiple sclerosis.
“After an MS diagnosis is confirmed, we usually would initiate or recommend some form of treatment, just because we know the outcome for most patients who remain untreated,” says Dr. Abbatemarco.
“There is evidence that patients [with relapsing-remitting MS (RRMS)] who remain off MS disease-modifying therapies will have more frequent relapses and more frequent disability accrual, and they’ll have a higher chance for developing secondary-progressive multiple sclerosis (SPMS),” Abbatemarco says.
SPMS is generally regarded as a stage of MS that follows RRMS, during which there is a steady progression of symptoms and disability, without noticeable periods of remission.
On the other hand, a study published in January 2019 in the Journal of the American Medical Association provides some evidence that treatment with more highly effective MS therapies soon after diagnosis is associated with a lower risk of transitioning to SPMS.
Disease Course of MS Is Unpredictable
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