Neurology

New developments in secondary-progressive MS – ECTRIMS 2019

 

SPECIAL REPORT

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Recent positive trials in primary- and secondary-progressive MS (ORATORIO, EXPAND) have fuelled interest in the etiology, pathophysiology and treatment of progressive MS (reviewed in Secondary-progressive MS: conceptual and practical challenges, NeuroSens, April 17, 2019; and Progressive MS trials – design and interpretation, NeuroSens, September 4, 2019). In Part 3 of this series, we summarize some emerging concepts in PMS and new trial data in SPMS. Read More

Report on higher-efficacy therapies in MS – ECTRIMS 2019

 

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Recent studies and physician surveys have reported an increasing use of higher-efficacy disease-modifying therapies in the treatment of MS. An analysis of the NeuroTransData MS registry in Germany found that in the periods 2010-2012 and 2016-2017, DMT use increased from 68.4% to 76.8% (Bergmann et al. ECTRIMS 2019; abstract P1063). Treatment was initiated about 3-4 months earlier from first MS symptom (mean 224 to 108 days) with a higher proportion now starting therapy within six months of diagnosis (83% to 92%). However, there was also greater volatility in DMT use – the mean time to discontinuing a DMT decreased from 19.9 months to 6.1 months, primarily due to adverse effects (16%) or lack of efficacy (13.9%). Switching is now primarily to an oral DMT (65.2%) or a MAb (46.6%) rather than to an injectable (16.4%). Annualized relapse rates (ARR) have declined over the past decade (from 0.23 to 0.16) but are similar for injectables (0.16), orals (0.16) and MAbs (0.12). For the most recent cohort, the mean time from first MS symptom to EDSS >3.5 is now 18.8 years, with only a low number of patients (1.6%) converting to SPMS. Read More