Early treatment: PreCISe-ly what the patient needs

Multiple sclerosis usually begins in young adulthood, and presents in 80-90% of patients with an initial disease course typified by relapses and remissions. The ability to recognise an individual's first neurological episode, commonly called a clinically isolated syndrome (CIS), represents a significant advance in the differential diagnosis of multiple sclerosis and offers the possibility of intervening at an earlier stage. Of note, over eighty percent of patients with a clinically isolated syndrome and magnetic resonance imaging lesions go on to develop multiple sclerosis within three years. The effect of first line therapies has been shown to be more pronounced when they are used at disease onset compared to a more advanced disease stage. First-line therapeutics have reached a milestone where a significant portion of disease activity is either preventable or at least modifiable. The results of the PreCISe Phase III multicentre, double-blind, randomised trial of glatiramer acetate versus placebo in patients with clinically isolated syndrome with abnormal MRI have recently been published. The study demonstrated a significant delay in progression to clinically definite multiple sclerosis in patients receiving glatiramer acetate, as well as a reduction in the burden of disease, as measured by both the number of new T2 lesions and T2 lesion volume. Considering these and previous results, this treatment should be regarded as an essential addition to the armamentarium of drugs available for the earliest treatment of this devastating disease.