Are multiple sclerosis drugs effective at the onset of the disease later on?

MINNEAPOLIS – It was difficult to find treatments for advanced multiple sclerosis (MS). But new research can help neurologists figure out which drugs are best for people with an advanced form of MS called secondary progressive MS. The new study, published June 30, 2021 in Neurology®, the American Academy of Neurology’s medical journal, found that the more potent disease-modifying drugs were more effective at reducing relapses in secondary progressive MS than the less potent drugs found in the Usually safer to take. However, the researchers found no difference in the rate of disease progression between these two types of drugs.

Most people with MS are initially diagnosed with relapsing-remitting MS, which is characterized by a flare-up of symptoms called relapses, followed by periods of calm called remission. More than half of these people will eventually develop secondary progressive MS, which is a slow, steady worsening of the disease that may or may not involve relapses.

Multiple sclerosis is a difficult disease to treat and requires close monitoring as it is treated with a variety of drugs, some of which can have serious side effects. Highly effective drugs are prescribed in early-stage multiple sclerosis to treat the disease more aggressively, and have been found to be more effective in preventing flare-ups and modifying the progression of secondary progressive MS.

Study author Tomas Kalincik, MD, PhD, from the University of Melbourne in Australia.

1,000 people with secondary progressive MS took part in the study. Participants were followed for 10 years to see if they had relapses and if they became more disabled over time.

The researchers divided the participants into two groups, those who were treated with one of the more potent or highly potent drugs (natalizumab, alemtuzumab, mitoxantrone, ocrelizumab, rituximab, cladribine, and fingolimod), and those who were treated with one of the less effective drugs or low-active substances (interferon ß, glatiramer acetate and teriflunomide). People in each group were compared on factors such as degree of disability and the duration of their secondary progressive MS.

After considering the delay before a person begins to experience the benefits of a drug, the researchers found that in people with active disease or those who have had relapses within the past two years, people treated with high-potency drugs 30 % fewer had relapses than people treated with low-potency drugs. People in the high potency group had an average of 0.17 relapses per year compared to 0.27 relapses per year in the low potency group.

Our study, which found that highly effective therapies are superior to low-effectiveness therapies only in reducing relapse in people with active secondary progressive MS, provides neurologists with valuable guidance in choosing the most effective therapies for people with this form of MS. If the goal is to alleviate the persistent relapse activity, more effective therapy is warranted. However, when it comes to limiting the progression of disability in secondary progressive MS, both types of drugs show comparable effectiveness.

Tomas Kalincik, MD, PhD

One limitation of the study was that participants were grouped by those who were taking high-potency or low-potency therapies. However, therapies have not been studied individually. Kalincik said it is possible that individual therapies could have different effects on symptoms and disability and recommends examining them separately in future research.

View press release

The study was funded by the National Health and Medical Research Council in Australia, the Multiple Sclerosis International Federation in the UK, and the ARSEP Foundation and EDMUS Foundation in France.

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