Early Disease Modifying Therapy Initiation Associated With Improved MS Relapse Control

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Early initiation of dimethyl fumarate and fingolimod may be associated with improved relapse control in multiple sclerosis relative to late therapy initiation.
Early initiation of dimethyl fumarate and fingolimod may be associated with improved relapse control in multiple sclerosis relative to late therapy initiation.

The following article is part of conference coverage from the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in Berlin, Germany. Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from ECTRIMS 2018.

Early initiation of dimethyl fumarate and fingolimod may be associated with improved relapse control in multiple sclerosis relative to late therapy initiation., according to research presented at the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis, held October 10-12, 2018, in Berlin, Germany.

This study included 808 individuals, 151 of whom were early starters of dimethyl fumarate and fingolimod and 151 others who were matched late starters. Subjects were followed for a median of 1.2 years (interquartile range [IQR], 1.0 to 1.9).

Compared with early starters, late starters were at increased risk of relapsing (incident rate ratio, 2.1; 95% CI, 1.2-3.8; P =.01). During the first 4 years of follow-up, the early group showed fractional relapse rates of 10/151, 5/62, 1/17, and 2/6, while rates in the late group were 20/151, 11/62, 3/17, and 1/6. These results were sustained with sensitivity analyses that varied inclusion criteria and matching strategies.

The original pool of data included 14,726 individuals in a Swiss multiple sclerosis treatment database who had initiated treatment with dimethyl fumarate between 1995 and 2017. Board-certified neurologists were responsible for providing data, which were prospectively recorded by use of a case-report form.

Patients with relapse-remitting multiple sclerosis who were starting dimethyl fumarate/fingolimod early were compared with those who had started with 2 or more years of interferon beta/glatiramer and then switched to dimethyl fumarate/fingolimod later.

Those who had relapsed within 1 year previous to switching were excluded from the study. Subpopulations were grouped by baseline characteristics using propensity score-matching. Negative binomial models were used as part of paired, pairwise censored analyses to compare relapse rates.

The study researchers conclude that “[early] commencement with [dimethyl fumarate]/[fingolimod] seems to be associated with a better control of relapses relative to a late start even when late starters were treated with [interferon beta]/[glatiramer acetate] beforehand.”

Several authors report associations with pharmaceutical companies. For a full list of author disclosures, visit the reference.

For more coverage of ECTRIMS 2018, click here.

Reference

Lorscheider J, Schädelin S, Benkert P, et al. Early versus delayed initiation of fingolimod or dimethyl fumarate in relapsing-remitting multiple sclerosis. Poster presented at: 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis; October 10-12, 2018; Berlin, Germany. Poster P548.

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