Long-term disease-modifying therapies for patients with multiple sclerosis (MS) have been effective in reducing relapses and the accumulation of disabilities, according to study results published in Neurology.
The main goal of MS treatments is to prevent long-term disability from developing. The study’s researchers wanted to find out whether immunotherapy could prevent long-term disability in patients with relapsing-remitting MS.
In this observational cohort study, researchers rated patients (N = 14,717) with MS who were eligible for Class IV immunotherapy. They collected patient data from the MSBase registry.
71% of the patients were women (mean age 36 years; mean age at onset of disease 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 follow-up data for at least 15 years (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 than patients who received non-continuous treatment (annual relapse rate 0.32 versus 0.46; hazard ratio) [HR]0.60; 95% CI, 0.43-0.82; P = 0.0016) and less likely a 12 month confirmed disability accumulation event (disability accumulation 0.9 vs. 1.5 events at 15 years; HR 0.56; 95% CI 0.38-0.82 ; P = 0.0026).
Compared with untreated patients, fewer patients with continuous treatment achieved an EDSS step 6 (Expanded Disability Status Scale) after 15 years (41% versus 13%; HR 0.33; 95% CI 0.19-0.59; P = 0.00019). .
The study researchers observed no significant difference in the improvement in disability between the treated and untreated patients (HR 1.20; 95% CI 0.96-1.50; P = 0.1). They also observed similar patterns, stratified by disease duration and age, between these two cohorts.
Limitations of this study include observational design, the inability to assess delayed treatment effects, and the inability to generalize findings beyond MS patients who are followed up in academic centers.
These data showed that patients who received long-term immunotherapy had a lower risk of disease relapse and escalation of neurological disabilities. The study’s authors concluded that “sustained, long-term immunotherapy from early stages of MS is advisable as a strategy to maintain patient neurological capacity over the long term.”
Disclosure: Several authors have stated that they are part of the pharmaceutical industry. For a full list of the details, see the original article.
Kalincik T., Diouf I., Sharmin S. et al. Effect of disease-modifying therapy on disability in recurrent-remitting multiple sclerosis over 15 years. Neurology. Published online on December 28, 2020. doi: 10.1212 / WNL.0000000000011242