Top score poster: Meta-analysis on the effect of DMTs

A new meta-analysis of over 10,000 participants in 16 randomised trials investigating disease-modifying therapies (DMTs), including patients with progressive forms of MS, showed a 13% reduction of confirmed disability progression (CDP). A subsequent subgroup analysis indicated that this benefit was almost entirely attributable to the response in patients with active disease [1].

Although relapsing-remitting MS has several available therapies, only limited options are available for progressive forms of MS, such as primary (PPMS) and secondary progressive MS (SPMS) [2]. The current study investigated the benefit of DMTs on reducing the progression of disability in progressive forms of MS and the efficacy of DMTs on participants with more active/inflammatory MS. Dr Mirko Capanna (University of Genoa, Italy) presented the study that was awarded a Top Score Poster prize at ECTRIMS 2021.

A meta-analysis of 16 randomised studies was performed using time to CDP as endpoint, all of which used the Expanded Disability Status Scale to assess treatment effect. A total of 10,562 participants (3,489 PPMS and 7,073 SPMS) were included in the analysis. The meta-analysis demonstrated a statistically significant benefit in treating patients with progressive forms of MS, quantifiable with a 13% CDP rate reduction (HR 0.87; 95% CI 0.81–0.93; P<0.0001). Further evaluation indicated that there was a low risk of bias in the studies; heterogeneity between the studies was estimated to be only 2%.

Subsequent subgroup analyses from 6 of these studies compared the effect of DMT on patients with “active“ or “not active“ MS, using the burden of enhancing brain MRI lesions to define disease activity. According to this analysis (see Figure), the “active“ subgroup of progressive MS patients had a 33% reduction in CDP from intervention with DMT (HR 0.67; 95% CI 0.58–0.79), whereas the “not active“ subgroup only had a 10% reduction (HR 0.90; 95% CI 0.79–1.02). The interaction between these groups was highly significant (P=0.005).

Figure: Forest plot for subgroup analysis according to disease activity [1]



CI, confidence interval; DMT, disease-modifying therapy; HR, hazard ratio.

Dr Capanna concluded that reduction of CDP with immunomodulatory/immunosuppressive DMTs has a clear clinical benefit in progressive MS, but this benefit appears to be largely confined to progressive patients with active inflammatory disease.

1. Capanna M, et al. Effect of disease-modifying therapies on progressive multiple sclerosis: a meta-analysis of randomised clinical trials. P626, ECTRIMS 2021 Virtual Congress, 13­–15 October.
2. Tsivgoulis G, et al. PLoS One. 2015;10(12):e0144538.

 

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Posted on 9 December 202125 March 2024