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

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.

Escalation vs. Early Intense Therapy in Multiple Sclerosis

“…Interestingly, a recent Norwegian observational study has compared the short-term effect of initial HET (with natalizumab, fingolimod and alemtuzumab) vs. medium efficacy treatment. Initial HET was associated with a greater proportion of NEDA at years 1 and 2 compared to initial medium efficacy treatment (OR 3.9, p < 0.001, at year 1) [69].…”

Highly active disease and access to disease-modifying treatments in patients with relapsing-remitting multiple sclerosis in Poland

“…Starting a highly active DMT early after a diagnosis of MS has been shown to control the disease substantially better than escalation therapy. A registry-based study from Norway among c.700 patients with MS showed that those receiving highly active treatment as the first DMT were nearly four times more likely to achieve NEDA than were those receiving moderately effective medications [13]. In a study of Swedish and Danish real-world registries, patients in Sweden, 35% of whom started treatment with highly effective DMTs, were significantly less likely to develop 24-week confirmed disability progression than were Danish patients, of whom fewer than 8% received highly active medications as the first treatment [14].…”

The mosaic of autoimmunity – Finally discussing in person. The 13th international congress on autoimmunity 2022 (AUTO13) Athens

“…Therapeutic targets in the CNS attracted the most attention among speakers. Milo discussed recent studies showing the vitality of utilizing high efficacy treatment early in multiple sclerosis disease course for reducing disability accumulation and improving the overall course of the disease [ 160 ]. Furthermore, Beckers examined the importance of B cells in multiple sclerosis by underlining the success of B cell depletion therapies.…”