Effect of immunomodulatory drugs on Expanded Disability Status Score in multiple sclerosis – a prospective study

Objective: To evaluate the effectiveness of different immunomodulatory treatments in slowing disability progression in patients with multiple sclerosis (MS), using the Expanded Disability Status Scale (EDSS) over one year. Methods: This prospective observational before-and-after study was conducted at the Neurology Department, Dr. Ruth K. M. Pfau Civil Hospital Karachi, from July 2022 to December 2023. Newly diagnosed, drug-naive MS patients aged 14-50 years, meeting McDonald criteria, were enrolled and followed for 12 months. EDSS scores were recorded at baseline, 6 months, and 12 months post-treatment initiation. A Pearson correlation analysis was conducted to assess the association between different immunotherapies and EDSS scores at 12 months. Additionally, one-way ANOVA was used to compare EDSS scores across various immunotherapy groups, with post-hoc analyses performed to identify significant pairwise differences. Results: Fifty-six patients (majority aged 20–40 years, predominantly female) completed the study. Immunotherapy significantly reduced mean EDSS scores from baseline (5.49) to 12 months (4.67) (mean difference=0.82; p<0.001). However, there was no significant correlation between specific immunotherapies administered and EDSS scores after one year (r=-0.022, p=0.876). ANOVA revealed no significant differences in EDSS scores among different immunomodulatory agents (F (4,50) =0.204, p=0.935). Conclusion: Immunomodulatory treatments significantly improved disability outcomes in MS patients over one year. However, no specific agent demonstrated superior efficacy, emphasizing the importance of personalized treatment strategies in managing multiple sclerosis.