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Anti-inflammatory disease-modifying treatment and short-term disability progression in SPMS

Johannes Lorscheider, Vilija G Jokubaitis, Tim Spelman

    Neurology
    |August 11, 2017
    PubMed
    Abstract

    Insights

    Disease-modifying treatments show no significant benefit in reducing short-term disability progression for patients with secondary progressive multiple sclerosis (SPMS). This analysis suggests current therapies do not substantially alter relapse-unrelated disability outcomes up to four years post-conversion.

    Area of Science:

    • Neurology
    • Clinical Trials
    • Epidemiology

    Background:

    • Secondary progressive multiple sclerosis (SPMS) is characterized by progressive disability accumulation.
    • Disease-modifying treatments (DMTs) are used in multiple sclerosis (MS) management, but their efficacy in SPMS is debated.
    • Short-term disability outcomes in SPMS are critical for assessing treatment effectiveness.

    Purpose of the Study:

    • To evaluate the impact of disease-modifying treatment (DMT) on short-term disability outcomes in patients with secondary progressive multiple sclerosis (SPMS).
    • To compare disability progression between treated and untreated SPMS patients using a validated definition and propensity score matching.

    Main Methods:

    • Utilized MSBase, an international MS patient registry, to identify and analyze patients meeting a validated SPMS definition.
    • Employed propensity score matching to create comparable groups of treated and untreated SPMS patients.
    • Conducted pairwise-censored analyses to compare disability outcomes, adjusting for treatment persistence, visit density, and relapse rates.

    Main Results:

    • Analysis of 1,378 matched patients (689 treated, 689 untreated) with a median follow-up of 2.1 years found no significant difference in 6-month sustained disability progression (HR 0.9, p=0.27).
    • No significant differences were observed in secondary endpoints, including the risk of reaching an Expanded Disability Status Scale (EDSS) score ≥7 (HR 0.6, p=0.10) or disability reduction (HR 1.0, p=0.79).
    • Changes in overall disability burden, measured by the area under the EDSS-time curve, also showed no significant difference between groups (β = -0.05, p=0.09).

    Conclusions:

    • Current disease-modifying agents, when initiated after conversion to SPMS, demonstrate no substantial effect on relapse-unrelated disability outcomes as measured by the EDSS up to four years.
    • The findings suggest that DMTs may not significantly alter the short-term disability trajectory in SPMS.
    • Class IV evidence indicates no beneficial effect of DMTs on short-term disability progression in SPMS patients.

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