Ten years of monoclonals in MS have not made an obvious dent in disability progression

Abstract

We audited the clinical characteristics of 327 patients with MS and clinical onset with either a transverse myelitis (TM) or optic neuritis (ON) at our two MS specialist centres. We compared those diagnosed in 2000–2010 and 2010–2020 to determine if MS disability progression is being altered by the use of mono- clonal disease modifying treatments. Our hypothesis was that TM onset disease might no longer carry a worse clinical prognosis.More patients are being treated with monoclonals first line in the last decade (TM 12% to 27%, ON 7% to 11%). The time to MS diagnosis is shorter (5 months for TM and 25 months for ON), as was the time to treatment (4 years for both TM and ON). Contrary to our expectations, patients presenting with ON or TM during 2010–20 did not have a reduced risk of reaching EDSS 4.0. In fact, those with TM onset MS diagnosed in the last decade performed the worst overall, with 50% of the cohort reaching EDSS 4.0 within four years. Our study suggests that the effect of monoclonals is not as positive as widely assumed and pragmatic randomised trials are needed to test their real value in clinical practice.christopher.allen@nottingham.ac.uk