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Comparing real-world effectiveness of DMTs

Presented by
Prof. Marcello Moccia, University College London, UK

In a cohort study, ocrelizumab proved to be superior to other disease-modifying treatments (DMTs) in achieving no evidence of disease activity (NEDA-3), as well as in reducing relapse risk and Expanded Disability Status Scale (EDSS) worsening. MRI results were less contrasting, possibly due to the limited sample size which was analysed.

A cohort study (1997–2021) aimed to evaluate the real-world effectiveness of different DMTs using relapses, EDSS, and MRI activity [1]. Included were 1,986 relapsing MS patients with an average age of 39 years, 71.2% were women, and time since diagnosis was 8.4 years. Used as DMTs were dimethyl fumarate (n=670), glatiramer acetate (n=547), fingolimod (n=336), ocrelizumab (n=256), or natalizumab (n=177). The mean follow-up was 5.81±5.85 years.

Compared with ocrelizumab (which was used as a reference), the probability of relapse after 1 year was higher with glatiramer acetate (OR=27.27), dimethyl fumarate (OR 10.60), fingolimod (OR 16.28), and natalizumab (OR 17.20). After 2 years, probability of relapse was higher with glatiramer acetate and fingolimod versus ocrelizumab; there were no differences with dimethyl fumarate and natalizumab (see Figure). Again compared with ocrelizumab, EDSS was higher after 1 year with dimethyl fumarate, fingolimod, glatiramer acetate, and natalizumab. The same was true after 2 years (see Figure).

Figure: Relative probability of relapse and MRI lesions at year 1 and 2 [1]

The probability of new/Gd-enhancing lesions was higher with glatiramer acetate (OR 4.02; 95% CI 1.74–9.27; P<0.01) compared with ocrelizumab. No differences were found for dimethyl fumarate (P=0.42), fingolimod (P=0.87), and natalizumab (P=0.11). The probability to achieve NEDA-3 status was lower in all groups compared with ocrelizumab. NEDA-3 was achieved by 90.23% of participants in the ocrelizumab group. For glatiramer acetate this percentage was 44.24% (HR 12.52; 95% CI 9.55–16.42; P<0.01), for dimethyl fumarate 62.08% (HR 1.66; 95% CI 1.30–2.11; P<0.01), for fingolimod 54.16% (HR 2.98; 95% CI 2.35–3.77; P<0.01), and for natalizumab 57.72% (HR 1.71; 95% CI 1.32–2.21; P<0.01). Ocrelizumab was superior to natalizumab in propensity score-adjusted analyses, which does not necessarily translate into differences at the level of the individual MS patients with high disease activity.

In summary, ocrelizumab was superior to other DMTs in achieving NEDA-3 and EDSS worsening. The less striking MRI results require ongoing analysis in a larger patient group.

  1. Moccia M. Comparing clinical and radiological effectiveness of disease modifying treatments in the real-world. Abstract O018, ECTRIMS 2022, 26–28 October, Amsterdam, the Netherlands.

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