Beyond Efficacy: Persistence, NEDA, and Therapeutic Decision-Making in First-Line Multiple Sclerosis Treatment

Area of Science:

• Neurology
• Immunology
• Pharmacology

Background:

• Injectable disease-modifying therapies (DMTs) like interferon-beta and glatiramer acetate (BRACE), alongside oral DMF and TER, are common initial treatments for multiple sclerosis (MS).
• Limited real-world data exists comparing long-term persistence and comprehensive disease control for these initial MS therapies.

Purpose of the Study:

• To compare the real-world, long-term treatment persistence and effectiveness of injectable BRACE versus oral DMF and TER in patients with multiple sclerosis.
• To evaluate the impact of treatment modality on achieving and maintaining no evidence of disease activity (NEDA) status.

Main Methods:

• Retrospective analysis of 400 MS patients initiating BRACE (n=132), DMF (n=130), or TER (n=138) between 2014-2024.
• Persistence defined as continuous treatment for ≥6 months. Effectiveness assessed by cumulative NEDA-2 (no relapse, no disability progression) and NEDA-3 (NEDA-2 + no MRI activity) status.

Main Results:

• Injectable BRACE had significantly higher discontinuation rates (70.5%) compared to TER (42.0%) and DMF (48.5%) (p<0.001).
• Median time to discontinuation was 3.55 years for BRACE, 4.88 years for TER, and 5.78 years for DMF.
• No significant differences in NEDA-2 or NEDA-3 survival were observed between the groups, though TER showed higher 1-year NEDA-2 rates than DMF and BRACE.

Conclusions:

• Oral MS therapies (DMF, TER) demonstrate superior long-term persistence compared to injectables (BRACE) in real-world clinical practice.
• Treatment effectiveness, as measured by cumulative NEDA-3, was comparable across oral and injectable DMTs.
• Patient-centered factors like tolerability and administration route significantly influence treatment adherence and persistence in MS management.