Early High Efficacy Treatment in Multiple Sclerosis Is the Best Predictor of Future Disease Activity Over 1 and 2 Years in a Norwegian Population-Based Registry.

Cecilia Smith Simonsen,Elisabeth Gulowsen Celius,Cathrine Brunborg,Pål Berg-Hansen,Stine Marit Moen,Line Broch,Heidi Øyen Flemmen

doi:10.3389/fneur.2021.693017

Abstract

Background: Moderate and high efficacy disease modifying therapies (DMTs) have a profound effect on disease activity. The current treatment guidelines only recommend high efficacy DMTs for patients with highly active MS. The objective was to examine the impact of initial treatment choice in achieving no evidence of disease activity (NEDA) at year 1 and 2.Methods: Using a real-world population-based registry with limited selection bias from the southeast of Norway, we determined how many patients achieved NEDA on moderate and high efficacy DMTs.Results: 68.0% of patients who started a high efficacy DMT as the first drug achieved NEDA at year 1 and 52.4% at year 2 as compared to 36.0 and 19.4% of patients who started a moderate efficacy DMT as a first drug. The odds ratio (OR) of achieving NEDA on high efficacy drugs compared to moderate efficacy drugs as a first drug at year 1 was 3.9 (95% CI 2.4–6.1, p < 0.001). The OR for high efficacy DMT as the second drug was 2.5 (95% CI 1.7–3.9, p < 0.001), and was not significant for the third drug. Patients with a medium or high risk of disease activity were significantly more likely to achieve NEDA on a high efficacy therapy as a first drug compared to moderate efficacy therapy as a first drug.Conclusions: Achieving NEDA at year 1 and 2 is significantly more likely in patients on high-efficacy disease modifying therapies than on moderate efficacy therapies, and the first choice of treatment is the most important. The immunomodulatory treatment guidelines should be updated to ensure early, high efficacy therapy for the majority of patients diagnosed with MS.

Highlights

Multiple sclerosis is a chronic neuroinflammatory disease with onset in mostly young people, and it is the commonest cause of serious physical disability in adults of working age [1]
If we had a negative finding in one of the three components of no evidence of disease activity (NEDA), we considered the patient as NEDA fail even though we did not have one or two of the other components (EDSS, magnetic resonance imaging (MRI) and/or relapse)
The odds ratio of achieving NEDA on a high efficacy disease modifying therapies (DMTs) as first drug at year 1 was 3.9 and at year 2 was 4.6 compared to moderate efficacy DMTs (Table 5)

Summary

Introduction

Multiple sclerosis is a chronic neuroinflammatory disease with onset in mostly young people, and it is the commonest cause of serious physical disability in adults of working age [1]. Interferon as a treatment for multiple sclerosis (MS) was first approved in 1996 [3]. In 2006, natalizumab was approved as the first high efficacy disease modifying therapy (DMTs) [4], and in the following years more DMTs followed suit. The current European and American treatment guidelines only advise the use of high efficacy drugs for highly active disease [6, 7]. Moderate and high efficacy disease modifying therapies (DMTs) have a profound effect on disease activity. The current treatment guidelines only recommend high efficacy DMTs for patients with highly active MS. The objective was to examine the impact of initial treatment choice in achieving no evidence of disease activity (NEDA) at year 1 and 2

Objectives

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Results

Discussion

Conclusion