Early Treatment (Tx) Seems to Lower Risk to Secondary Progressive MS

Newer disease-modifying treatments better than older ones at reducing conversion risk
by Vicki Brower, CME Writer, MedPage --- January 23, 2019

CME Author: Vicki Brower

Study Authors: J. William L. Brown, Alasdair Coles, et al.; Ari Green

Target Audience and Goal Statement:

Neurologists, internists, and family medicine specialists

The goal was to determine the association between the use, type, and timing of disease-modifying treatments (DMTs) for multiple sclerosis (MS) with regard to the risk of conversion to objectively defined secondary progressive disease from relapsing-remitting MS.

Questions Addressed:

• For MS patients with relapsing-remitting disease, what is the association between DMTs and the risk of conversion to secondary progressive MS?
• Are there any differences among DMTs with regard to postponing conversion to secondary progressive MS, and if so, which are the most effective?
• Does treatment timing matter in postponing conversion to progressive disease?

Study Synopsis and Perspective:

MS patients treated initially with newer DMTs, namely, fingolimod (Gilenya), natalizumab (Tysabri), or alemtuzumab (Lemtrada) had a lower risk of converting to secondary progressive MS than patients who began treatment with glatiramer acetate (Copaxone) or interferon beta (Rebif), according to a new study.

But compared with MS patients who received no treatment, those who were initially treated with any of these therapies, or even with glatiramer acetate or interferon beta, had a lower risk of disease conversion to secondary progressing MS, according to Tomas Kalincik, PhD, of the Royal Melbourne Hospital in Australia, and colleagues. The authors noted that "no licensed therapies have shown greater reduction in relapse rates than natalizumab or alemtuzumab."

The effects of all treatments in this international observational cohort study were more significant when they were begun within the first 5 years of disease onset, they wrote in JAMA.

"This has been a very large question for some time: Can we really show that earlier use of these disease-modifying therapies actually results in a delay of entry into secondary progressive phase of the illness?" said John Corboy, MD, of the University of Colorado in Denver, who was not involved in the study.

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