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New Study Shows the Benefits of MS Therapies Against Future Disease Progression

February 22, 2019

Originally posted 1/18/19
UPDATED With Another Study Reporting Similar Findings – See Below

SUMMARY
  • An observational study of 1,555 people with MS adds evidence that treating MS, treating it with high efficacy therapies, and treating it early, are all associated with significant decreases in the risk for progression from relapsing-remitting to secondary progressive MS.
  • The team (J. William L. Brown, MRCP, University of Cambridge, and Tomas Kalincik, PhD, University of Melbourne, and colleagues) report their findings in JAMA Neurology (2019;321(2):175–187).
  • Although this type of observational study cannot provide the same level of evidence as a well-designed, controlled clinical trial, Ari Green, MD (University of California, San Francisco) suggests in an editorial that, based on this and other studies, “The signs are strongly pointing to the benefits of early and aggressive treatment to forestall damage.” He cautions that the study did not show that disease modifying therapies can stop MS completely since a significant number of people studied did develop secondary progressive MS. 
  • UPDATE 2/22/19: A second study has reported that people with MS prescribed early, high efficacy therapies tended to have less progression of disability than those who started with traditional disease-modifying treatments. The team (Katharine Harding, PhD, Neil Robertson, MD, and colleagues at Cardiff University, Heath Park, Cardiff, UK) reported their results in JAMA Neurology (Published online February 18, 2019).
DETAILS
Background: Many people who are diagnosed with relapsing-remitting MS eventually transition to a secondary progressive course in which there is a progressive worsening of neurologic function (accumulation of disability) over time. There has been some evidence that early and ongoing treatment with MS disease-modifying therapies is the best way to reduce current and future disease activity, but specific information is needed about the timing and best types of therapies to achieve the optimal impacts against the disease. A team of researchers including J. William L. Brown, MRCP, University of Cambridge, and Tomas Kalincik, PhD, University of Melbourne, and colleagues sought to determine the association between the use, the type of, and the timing of disease-modifying therapies with the risk of conversion to the secondary progressive phase of MS.
 
The Study: Investigators looked at records of 1,555 people with relapsing-remitting MS who began treatment with disease-modifying therapies from 1988-2012, or who remained untreated, and who had been followed for at least four years. Treated individuals were identified in MSBase, an international online registry that currently includes records of more than 60,000 people with MS from hundreds of clinics worldwide. Untreated individuals for the study were selected from the database of the University Hospital of Wales.
 
People who took fingolimod, alemtuzumab, and natalizumab (“higher-efficacy therapy” therapies with greater effectiveness but possibly more risk of side effects) were compared with those initially treated with glatiramer acetate or interferon beta (traditional, first generation disease-modifying therapies). Those initially treated with glatiramer acetate or interferon beta within five years of MS onset were compared with those initially treated after five years. Investigators also looked at whether treatment was escalated from traditional to higher-efficacy within five years or later.
 
The outcome being measured in all these comparisons was conversion to secondary progressive MS, which was defined as an increase of 1 point on the EDSS scale of disability progression (if the EDSS score was 5.5 or less) or .5 point (if the EDSS score was more than 5.5). This EDSS increase had to occur without a relapse and be confirmed after 3 months or more.
 
Results: The investigators report that people who were treated with any type of disease-modifying therapy were significantly less likely to later develop secondary progressive MS than those who remained untreated. In addition, they reported that initial treatment with the higher-efficacy therapies was associated with a significantly decreased risk of conversion to secondary progressive MS compared with treatment with initial treatment with traditional therapies. They also found that the risk of developing secondary progressive MS was significantly lower when treatment was started within five years of MS onset compared to after five years, and when treatment was escalated from traditional therapy to a higher-efficacy therapy in the first five years compared to later.
 
The team (J. William L. Brown, MRCP, University of Cambridge, and Tomas Kalincik, PhD, University of Melbourne, and colleagues) report their findings in JAMA (2019;321(2):175–187).
 
Conclusions: Although this type of observational study cannot provide the same level of evidence as a well-designed, controlled clinical trial, Ari Green, MD (University of California, San Francisco) suggests in an editorial that, based on this and other studies, “The signs are strongly pointing to the benefits of early and aggressive treatment to forestall damage.” He cautions that the study did not show that disease modifying therapies can stop MS completely since a significant number of people studied did develop secondary progressive MS. 
 
Further studies are underway in this area. The TREAT-MS Trial is one of two studies funded by the Patient-Centered Outcomes Research Institute that will help inform treatment decisions around whether, and which, people with MS would most benefit from early, possibly more risky aggressive therapy. The other study is Determining the Effectiveness of Early Intensive versus Escalation Approaches for the Treatment of Relapsing-Remitting Multiple Sclerosis (DELIVER-MS).

UPDATE 2/22/19: Further Results on Early, Aggressive Treatment
A second study has reported that, among 592 people with MS, 104 who were prescribed early high efficacy therapies had more favorable outcomes as measured by the EDSS, compared with 488 people who started with traditional disease-modifying treatments. The team (Katharine Harding, PhD, Neil Robertson, MD, and colleagues at Cardiff University, Heath Park, Cardiff, UK) reported their results in JAMA Neurology (Published online February 18, 2019).
 
Read about the study on the Cardiff University website
Read more about modifying the disease course in MS

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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