OBJECTIVES : To explore the impact of early DMT treatment initiation and use of HET on clinical and health outcomes in patients with MS.

METHODS : A targeted literature review was conducted using Embase (including Medline) to identify studies published from January 2006-March 2020. Search terms included clinical-outcomes: annualized relapse rate (ARR), disability progression, magnetic resonance imaging (MRI) outcomes; and health-related outcomes: quality of life (QoL), work-productivity, therapy persistence, and healthcare resource utilization (HCRU).

RESULTS : Among the screened studies, 69 were included in this review (50 observational studies, 18 clinical trials, and 1 systematic review; 35 US/Canadian, 20 global, 12 European, and 2 Australian studies). ARR and disease progression were the most common outcomes in the included studies. Inhibition of MS disability, slower disease progression, lower ARR, improved persistence/adherence, cost-savings, and decrease in HCRU were achieved if a DMT was initiated early following diagnosis. Definition of HET varied across studies; while most studies identified infused DMTs as HET, some studies also included fingolimod as HET. Use of HET was associated with improvements in QoL, work productivity, therapy persistence, and reduction in hospitalizations. Of 4 studies which evaluated early initiation of HET (E-HET), all favored the induction vs escalation approach. Overall, several studies found that E-HET in the MS disease process produced greater efficacy in reducing relapse rate, MRI-activity, brain atrophy, and long-term disease progression. However, no studies were identified that addressed the effect of E-HET on health-related outcomes.

CONCLUSIONS : Emerging evidence suggests that initiating E-HET in MS leads to better clinical outcomes while HET use is associated with improved health-related outcomes. However, a need exists to better understand the humanistic and economic benefits of initiating E-HET in the MS disease course and in standardizing the definition of HET to better inform treatment decision-making for patients and providers.