Outcomes are poor for relapsing-remitting MS patients receiving platform therapy (pDMT) as first treatment, but a younger subgroup may benefit from pDMT.
In a real-world study of patients with relapsing-remitting multiple sclerosis (RRMS), the majority receiving a platform therapy (pDMT) as first treatment, either followed by a switch to a high-efficacy DMT (heDMT) or not, had poor outcomes; however, a subgroup might benefit. These results were presented at EAN 2023 by Ilaria Addazio and colleagues, who concluded that pDMT may be considered in young adults with monofocal MS onset, short disease duration, and low disability levels.
The two main treatment approaches in RRMS are escalation versus early aggressive treatment, Escalation entails starting with moderately effective pDMT and switching to heDMT in case of disease activity, while early aggressive means early application of highly effective DMTs. Addazio and colleagues set out to identify the proportion and characteristics of patients who can obtain greater benefits from pDMT.
The researchers extracted records from the Italian MS Registry of 7,852 patients with RRMS patients starting a pDMT (interferons, glatiramer acetate, teriflunomide, dimethyl fumarate, or azathioprine) with follow-up data of 10 years or more. Optimal responders to pDMT (patients without 6-month confirmed disability accrual [CDA] who did not switch) were compared with patients remaining on pDMT experiencing a CDA, and patients switching to heDMT.
The mean follow-up was 14.7 (SD, 3.76) years. There were 2,112 (26.9%) optimal responders to pDMT, 2,238 (28.5%) who had a CDA, and 3,502 (44.6%) switchers to a heDMT. Optimal responders were relatively younger (OR, 0.96; 95% CI, 0.95-0.97; P<0.001) and had a shorter disease duration at baseline (OR, 0.97; 0.96-0.98; P<0.001). Compared with switchers, optimal responders had
- Older age (OR, 1.03; 1.02-1.04; P<0.001)
- Shorter disease duration at baseline (OR, 0.98; 0.97-0.99; P<0.001)
- Lower EDSS at baseline (OR, 0.76; 0.72-0.80; P<0.001)
- Monofocal onset (OR, 1.26; 1.05-1.51; P=0.011)
- Fewer relapses in the year previous to baseline (OR, 0.92; 0.86-0.97; P=0.004)
A multivariable analysis of MRI data (n=4,500) showed that, compared with pDMT with CDA, optimal responders had
- Younger age (OR, 0.96; 0.94-0.96; P<0.001)
- Active MRI at baseline (OR, 1.23; 1.03-1.46; P<0.001)
- Shorter disease duration at baseline (OR, 0.98; 0.97-0.99; P=0.019)
Thus far, no differences in oligoclonal band positivity between groups had been noted. The analysis of MRI and cerebrospinal fluid parameters is still ongoing.
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