The following article is part of conference coverage from the 8th Joint American Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) and European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) MSVirtual2020 event. Neurology Advisor‘s staff will be reporting breaking news associated with research conducted by leading experts in neurology. .
Disease modifying therapies (DMTs) show the greatest effectiveness among those with multiple sclerosis (MS) who have shorter MS duration, lower scores on the Expanded Disability Status Scale (EDSS), lower rate of relapse, and the relapsing MS phenotype, according to research presented at the 8th Joint American Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) and European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) MSVirtual2020 event, held September 11-13, 2020.
This retrospective study included 26,329 individuals with relapsing or progressive MS selected from the international MSBase registry. Inclusion criteria consisted of being followed for ≥1 year, with ≥3 visits, and ≥1 visit per year. Study researchers compared the hazard ratios (HR) of EDSS improvement and 6-month confirmed worsening, as well as relapse rates between treated and untreated periods. Marginal structural models were used to do so and were continuously readjusted to take into account participant sex, age, date, pregnancy, previous relapse history, time from first symptom, MRI activity, and disability.
Among 23,687 individuals with relapsing MS, those treated with DMTs were 20% more likely to experience disability improvement (HR 1.20; 95% CI, 1.0-1.5), 47% less likely to experience worsening disability (HR 0.53; 95% CI, 0.39-0.71), and had a 51% decrease in relapses (HR 0.49; 95% CI, 0.43-0.55). However, longer MS duration and higher previous rate of relapse reduced the effect of DMTs on relapses and EDSS worsening; the effect of DMTs on these factors was stronger among those in lower EDSS categories.
The use of DMTs was associated with greater EDSS improvement among those without new MRI lesions (HR 1.51; 95% CI, 1.00-2.28) than those with MRI activity (HR 1.04; 95% CI, 0.88-1.24). Among the 26,329 individuals with either relapsing or progressive MS, those with relapsing MS treated with DMTs showed reductions in both EDSS worsening (HR 0.75; 95% CI, 0.65-0.86) and relapses (HR 0.58; 95% CI, 0.54-0.62). However, these benefits were not observed in those with progressive MS.
The study researchers concluded, “DMTs are associated with reduction in relapse frequency, progression of disability, and increased chance of recovery from disability.” however, “subgroups with shorter MS duration, lower EDSS, lower relapse rate and relapsing MS phenotype” appear more likely to experience benefits from DMTs.
Visit Neurology Advisor‘s conference section for continuous coverage from the ACTRIMS/ECTRIMS MSVirtual2020 Forum.
Diouf I, Malpas C, Horakova D, et al. Variability of the response to immunotherapy among sub-groups of patients with multiple sclerosis. Presented at: 8th Joint American Committee for Treatment and Research in Multiple Sclerosis and European Committee for Treatment and Research in Multiple Sclerosis MSVirtual2020 event; September 11-13, 2020. Abstract P0018.