Need for early, effective treatment: MSBase investigators


REPORT FROM ECTRIMS – BARCELONA, SPAIN – OCTOBER 7-10, 2015 – There is a need for early intervention with more effective therapies to slow disability progression, according to a series of analyses by the MSBase investigators.

Some database analyses have suggested comparable long-term outcomes with or without treatment with a disease-modifying therapy. Accordingly, the MSBase registry was used to identify clinical and treatment-related predictors of long-term disability, as assessed by a change in EDSS score at 8 or 10 years (Jokubaitis et al. ECTRIMS 2015; P281). Eight and 10 year data were available for 2,148 and 1,480 subjects, respectively.  Overall, annualized relapse rate was highly predictive of EDSS change at 8 and 10 years. Relapses that occurred on therapy were more likely to be associated with EDSS progression compared to relapses off therapy. Moreover, time on therapy was associated with significant decreases in EDSS scores at 8 and 10 years. EDSS change was significantly less at 8 years in women who became pregnant, and a trend to better outcomes was seen at 10 years.

MSBase also examined whether the type of relapse influences the accumulation of disability (Stewart et al. ECTRIMS 2015; abstract EP1392). Data were obtained for 32,349 patients from 87 MS centres. Overall, there was a strong association between the number of relapses and the amount of EDSS change. Relapses presenting with bowel/bladder dysfunction, cerebellar or pyramidal symptoms, and cognitive signs/symptoms had the greatest impact on disability accrual. There was a lesser impact on accumulation of disability with sensory or visual relapses.

A separate MSBase analysis looked at whether DMTs could modify the development of disability (Lizak et al. ECTRIMS 2015; abstract P636). The database included 32,336 patients from 108 MS centres. Outcomes were compared for patients treated with lower efficacy agents (IFNbeta, glatiramer acetate, teriflunomide) and higher efficacy agents (fingolimod, natalizumab, DMF, cladribine, rituximab, alemtuzumab, mitoxantrone).  The risk of reaching key disability milestones (EDSS 3, 4 or 6) was higher in patients with a higher ARR and lower long-term adherence to a higher-efficacy agent. More prolonged exposure to a higher efficacy DMT significantly reduced the risk of further accumulation of disability throughout the disease course.

Reviewer: Dr. Daniel Selchen, Head of Neurology, St. Michael’s Hospital, Toronto, Canada

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