Exit strategy patterns in second-line therapies for relapsing forms of multiple sclerosis

Area of Science:

• Neurology
• Immunology
• Clinical Research

Background:

• Relapsing-remitting multiple sclerosis (RRMS) management frequently requires treatment adjustments due to safety, efficacy, or patient factors.
• Real-world data on outcomes after switching or discontinuing advanced therapies like natalizumab and ocrelizumab remain limited.

Purpose of the Study:

• To analyze treatment transition patterns and reasons for discontinuation in RRMS patients on second-line therapies.
• To evaluate clinical and MRI outcomes six months after switching or discontinuing second-line RRMS treatments.

Main Methods:

• A retrospective cohort study involving 338 RRMS patients at Sina Hospital, Tehran, Iran.
• Data on clinical and MRI parameters were collected at baseline and six-month follow-up after therapy changes.
• Outcomes assessed included relapse frequency, Expanded Disability Status Scale (EDSS) changes, and MRI lesion activity.

Main Results:

• Ocrelizumab (42.3%) and rituximab (33.4%) were the most common destinations for treatment transitions.
• Primary reasons for switching included safety concerns (32.0%) and inadequate efficacy (29.9%).
• A subgroup switching from fingolimod to ocrelizumab showed a significant EDSS reduction (mean difference 0.19, p=0.019); patients switching due to inadequate efficacy also showed significant EDSS improvement (mean difference 0.25, p<0.001).

Conclusions:

• B-cell depleting therapies, especially ocrelizumab, show potential in reducing disability in active RRMS.
• Personalized treatment strategies balancing efficacy, safety, and patient factors are crucial for managing RRMS.
• Further prospective studies are necessary to confirm the long-term benefits of these treatment transitions.