Initial high-efficacy disease-modifying therapy in multiple sclerosis: A nationwide cohort study

Area of Science:

• Neurology
• Immunology
• Clinical Trials

Background:

• Multiple sclerosis (MS) management involves selecting disease-modifying therapies (DMTs) based on efficacy.
• Treatment-naive patients represent a critical group for initial therapeutic decisions.
• Understanding the comparative effectiveness of high-efficacy (heDMT) versus medium-efficacy (meDMT) DMTs is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the effectiveness of heDMTs versus meDMTs as first-line treatments in treatment-naive MS patients.
• To evaluate the impact of initial heDMT versus meDMT on disability progression and relapse rates.
• To assess outcomes using a nationwide population-based registry.

Main Methods:

• A nationwide, population-based multiple sclerosis registry was utilized.
• Patients initiating heDMT as first-time treatment were identified and compared to a propensity score-matched sample of patients starting meDMT.
• Outcomes including 6-month confirmed Expanded Disability Status Scale (EDSS) worsening and first relapse were analyzed over 4 years.

Main Results:

• A total of 388 patients were included (194 heDMT initiators, 194 meDMT initiators).
• The probability of 6-month confirmed EDSS worsening was significantly lower for heDMT initiators (16.7%) compared to meDMT initiators (30.1%) (HR 0.53, p=0.006).
• Patients initiating heDMT also showed a lower probability of a first relapse (HR 0.50).

Conclusions:

• Initiating high-efficacy disease-modifying therapies (heDMT) as first-line treatment in treatment-naive multiple sclerosis patients leads to a lower probability of disability worsening and relapses compared to medium-efficacy DMTs (meDMT).
• These findings suggest that early treatment with heDMT may be more beneficial for long-term disease management in MS.
• The study provides Class III evidence supporting the use of heDMT over meDMT for initial therapy in MS.