Time matters in multiple sclerosis: can early treatment and long-term follow-up ensure everyone benefits from the latest advances in multiple sclerosis?

Introduction

The management of multiple sclerosis (MS) has been a neurology success story for the past 25 years. Advances in understanding of the disease mechanisms and the dynamic nature of the disease have brought around 12 disease-modifying therapies (DMTs) to market in many countries.

However, treatment is hampered by adverse effects and by limited evidence of efficacy in more advanced 'progressive' MS. Some patients do not receive DMTs for years after diagnosis, or are told medication can no longer help as their disability is worsening. The cost of DMTs is also a significant issue, especially in low-income and middle-income countries.

MS affects an estimated 2.5 million people worldwide, with a higher prevalence and incidence in the northern hemisphere.1 Patients with MS now have a longer life expectancy,2 3 in part because of earlier treatment. Accounting for comorbidities such as age-related vascular disease will become increasingly important in...

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