Rituximab most effective initial MS therapy in Swedish real-world study

Rituximab was associated with lower relapse risk and MRI lesions in treatment-naïve MS patients, compared with dimethyl fumarate, natalizumab, and injectable therapies (interferon-β, glatiramer acetate). Expanded Disability Status Scale (EDSS) score at 3 years was similar to dimethyl fumarate and natalizumab. The probability of switching therapy was lowest in rituximab users [1].

The register-based, COMBAT-MS (NCT03193866) study evaluated the effectiveness of the most frequently prescribed initial MS therapies in Sweden. MS patients ever-treated with initial rituximab (n=472), natalizumab (n=269), dimethyl fumarate (n=339), or injectables (interferon-β, glatiramer acetate; n=858), were followed between 2010 and 2020. Outcome measures were first relapse (time to event), MRI lesion rate, EDSS score, and time to treatment discontinuation. Rituximab served as the reference therapy. Mr Peter Alping (Karolinska Institutet, Sweden) shared the results.

Initial treatment with injectables demonstrated the highest probability of relapse (HR 6.0), followed by dimethyl fumarate (HR 2.9) and natalizumab (HR 1.8; see Figure). However, baseline characteristics showed that natalizumab users were on average younger and had experienced more relapses prior to the study onset. Rate ratios of MRI lesions favoured initial rituximab therapy over injectables (rate ratio 4.5), dimethyl fumarate (4.8), and natalizumab (1.9). Interestingly, only injectables demonstrated significantly higher EDSS scores than rituximab. Time to treatment discontinuation was shortest for injectables, followed by dimethyl fumarate and natalizumab. Reasons to discontinue dimethyl fumarate or injectables were mainly adverse events or inadequate efficacy. Natalizumab was frequently discontinued due to John Cunningham virus positivity and concerns of progressive multifocal leukoencephalopathy.

Figure: Time to first relapse for initial MS treatments [1]

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   1. Alping P, et al. Effectiveness of initial MS treatments in the COMBAT-MS trial: injectables, dimethyl fumarate, natalizumab and rituximab. OP34, ECTRIMS 2021 Virtual Congress, 13–15 October.

 

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Posted on 9 December 202115 February 2024