Long-term disease modifying therapies for patients with multiple sclerosis (MS) were effective at reducing relapse and disability accumulation, according to study results published in Neurology.
The predominant goal of MS treatments is the prevention of long-term disability accrual. Study researchers sought to determine whether immunotherapy could prevent long-term disability in patients with relapsing-remitting MS.
In this observational cohort study, researchers assessed patients (N=14,717) with MS who were eligible for class IV immunotherapy. They collected patient data from the MSBase registry.
71% of patients were women (mean age, 36 years; mean age at disease onset, 30±9 years) and had a median of 6 (interquartile range [IQR], 3.1-10) years of prospective follow-up data. Patients had a median of 4 (IQR, 2-6) relapses, and 69% were exposed to immunotherapies. A total of 1085 patients had at least 15 years of follow-up data (median years of prospective follow-up, 17 years; 95% CI, 15.6-18.8).
Patients who received continuous treatment were less likely to have a relapse event compared with those who were not continuously treated (annual relapse rate, 0.32 vs 0.46, respectively; hazard ratio [HR], 0.60; 95% CI, 0.43-0.82; P =.0016) and less likely to have a 12-month confirmed disability accumulation event (disability accumulation, 0.9 vs 1.5 events, respectively, at 15 years; HR, 0.56; 95% CI, 0.38-0.82; P =.0026).
Compared to untreated patients, fewer patients with continuous treatment reached an Expanded Disability Status Scale (EDSS) step 6 at 15 years (41% vs 13%, respectively; HR, 0.33; 95% CI, 0.19-0.59; P =.00019).
Study researchers did not observe significant difference in disability improvement between the treated and untreated patients (HR, 1.20; 95% CI, 0.96-1.50; P =.1). They also observed similar patterns, stratified by disease duration and age, between these two cohorts.
Limitations of this study include its observational design, the inability to assess delayed treatment effects, and the inability to generalize findings beyond patients with MS followed in academic centers.
These data indicated patients receiving long-term immunotherapy were at decreased risk for disease relapse and neurologic disability escalation. The study authors concluded that “sustained, long-term immunotherapy from early stages of MS is advisable as a strategy to preserve patients’ neurological capacity over the long-term.”
Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
Kalincik T, Diouf I, Sharmin S, et al. Effect of Disease Modifying Therapy on Disability in Relapsing-Remitting Multiple Sclerosis Over 15 Years. Neurology. Published online December 28, 2020. doi:10.1212/WNL.0000000000011242