Disease Modifying Therapy Most Beneficial Early in MS

Disease modifying therapy for multiple sclerosis (MS) tends to be most effective in patients with less disability and in relapsing MS phenotypes, according to study results published the European Journal of Neurology.

“Disease modifying therapies are most effective in controlling relapsing MS before patients have accumulated substantial neurological disability. They continue to reduce disease activity and disability worsening even in patients with Expanded Disability Status Scale ≥ 3 and age 45 or older,” wrote corresponding author Tomas Kalincik, MD, PhD, of the University of Melbourne Department of Medicine in Australia, and coauthors. 

The study included data from the MSBase registry for 61,810 patients with Expanded Disability Status Scale scores of 3 or higher. Patients were from 135 centers across 35 countries. 

Among 24,344 patients with relapsing MS, patients on disease modifying therapy experienced a 48% drop in relapses, a 46% reduced risk of disability worsening, and a 32% greater chance of disability improvement. On the other hand, in patients with more severe disability, a higher prior relapse rate, and prior cerebral activity on magnetic resonance imaging scans, disease modifying therapy had less of an effect. 

In nearly 2000 patients with progressive MS, disease modifying therapy’s effect on disability depended largely on the MS phenotype. Meanwhile, its effect on relapses was largely driven by prior relapse activity.

Researchers found no evidence that age played a role in effectiveness.

“Disease modifying therapies should therefore be initiated early,” researchers concluded, “but should be considered across all age groups, with careful evaluation of individual benefit-vs-risk ratios.”

Reference:
Diouf I, Malpas CB, Sharmin S, et al. Variability of the response to immunotherapy among sub-groups of patients with multiple sclerosis. Eur J Neurol. Published online January 24, 2023. doi:10.1111/ene.15706