Treatment outcomes of high-efficacy disease-modifying therapies in patients with relapsing-remitting multiple...

The evolution of high-efficacy disease-modifying therapies (HE-DMTs) has significantly shifted the management of relapsing-remitting multiple sclerosis (RRMS). Real-world evidence highlighted the role of HE-DMTs in improving disability and controlling disease activity.

To assess the real-world effectiveness, treatment patterns, and discontinuation patterns of HE-DMTs, including cladribine, natalizumab, ocrelizumab, alemtuzumab, fingolimod, and rituximab in RRMS patients.

This is a retrospective, observational, longitudinal, multicenter study that included 1,408 RRMS patients treated with HE-DMTs. Data were extracted from the Kuwaiti national MS registry. The primary objective of this study was to assess the proportion of patients with relapse-free status at 12 months. Secondary objectives included confirmed disability progression (CDP), confirmed disability improvement (CDI), Expanded Disability Status Scale (EDSS) changes, proportion of patients with no evidence of disease activity (NEDA-3), and treatment discontinuation patterns. Statistical analysis included descriptive analysis, paired-sample tests, and McNemar's tests.

After 12 months of treatment, first-line HE-DMTs resulted in high relapse-free (≥80%) and NEDA-3 (≥75%) rates, especially with ocrelizumab (90.6%, 82.7%, respectively) and natalizumab (88.4%, 81.9%, respectively). Significant EDSS reductions were achieved with natalizumab (-0.80), ocrelizumab (-0.46), and rituximab (-0.66) in patients receiving first-line HE-DMTs (p < 0.001). CDI rates were the highest with alemtuzumab (40.6%) and rituximab (22.1%) in the first-line setting. Discontinuation rates were highest for alemtuzumab due to scheduled stopping (86.9%), fingolimod due to adverse events (17.3%), and natalizumab due to JC virus sero-positivity (65.7%). Ocrelizumab had the lowest discontinuation rate (5.4%), mainly due to pregnancy confirmation or planning (56.5%).

Early initiation of HE-DMTs in RRMS patients had a significant clinical impact on disease activity and disability. Treatment effectiveness parameters were lower with later lines of therapy, highlighting the importance of early therapeutic intervention. High tolerability varied among DMTs, demonstrating the need for individualized treatment decisions.