Early Intensive Treatment May Improve Long-Term MS Outcomes
Mean five-year change lower in Expanded Disability Status Scale score with early intensive treatment
WEDNESDAY, Feb. 20, 2019 (Pharmacist's Briefing) -- Long-term outcomes are more favorable for early intensive treatment (EIT) versus first-line moderate-efficacy disease-modifying therapy (DMT) in multiple sclerosis (MS), according to a study published online Feb. 18 in JAMA Neurology.
Katharine Harding, Ph.D., from Cardiff University in the United Kingdom, and colleagues examined long-term outcomes in a cohort study analyzing data for 592 patients with MS prescribed DMT. Patients were classified by first-line treatment strategy: high-efficacy (EIT) or moderate-efficacy DMT (escalation [ESC]).
The researchers found that compared with the ESC group, the EIT group had a lower mean five-year change in Expanded Disability Status Scale score (0.3 versus 1.2); after adjustment for relevant covariates, this result remained significant (β = −0.85; 95 percent confidence interval, −1.38 to −0.32; P = 0.002). The median time to sustained accumulation of disability (SAD) was 6.0 and 3.14 years for EIT and ESC, respectively (P = 0.05). The median time to SAD was 3.3 years for those within the ESC group who escalated to high-efficacy DMT as second-line treatment (compared with EIT, group log-rank test P = 0.08). Of those who escalated to high-efficacy DMT, 60 percent developed SAD while still receiving initial moderate-efficacy treatment before escalation.
"Our study undermines the prevalent belief that an escalation approach represents a lower-risk strategy to MS treatment and suggests that in the real world, an escalation approach to DMT may be inadequate to prevent unfavorable long-term outcomes," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.