https://doi.org/10.55788/0d0b303c
The European Medicines Agency (EMA) restricts the use of certain disease-modifying treatments (DMTs) to MS patients with disabling relapses. For example, natalizumab and fingolimod can only be used in the first line in case of rapidly-evolving, severe MS, Dr Cyrus Daruwalla (Cambridge University Hospitals, UK) pointed out. Confronted with NDRs, a neurologist is uncertain about the prognostic significance and whether the NDRs should influence treatment. A study set out to determine whether NDRs early in the course of RRMS herald faster accumulation of disability than the absence of such relapses [1].
Prospectively-collected data was used from 78,531 participants from the MSBase international registry (msbase.org). Participants with NDRs only were compared with those with no relapses in the first 2 years after attaining clinically definite RRMS. To mitigate the confounding effect of DMTs, participants were stratified according to the highest-efficacy DMT they received during follow-up into no treatment, platform therapies, or high-efficacy DMT. For each group was assessed whether early NDRs were associated with 90-day confirmed disability accumulation events, defined as an increase in Expanded Disability Status Scale (EDSS) score of 1.0 (or 1.5 if the baseline EDSS=0, or 0.5 if the baseline EDSS>5).
Untreated RRMS participants with NDRs had a significantly higher risk of disability accumulation (+29%) than participants with no relapses (see Figure). Participants treated with platform DMTs who had NDRs, had a significantly increased risk of disability accumulation compared with participants without relapses. No difference was detected between users of high-efficacy DMTs and participants without relapses.
Figure: Disability accumulation for no treatment, platform therapies, or high-efficacy DMT [1]
DMT, disease-modifying treatments; RRMS, relapsing-remitting MS.
“Contrary to EMA guidance, NDRs should be considered in decisions to initiate or escalate treatment, including high-efficacy therapies,” concluded Dr Daruwalla.
- Daruwalla C, et al. Early non-disabling relapses are associated with a higher risk of disability accumulation in people with relapsing-remitting multiple sclerosis. Abstract O178, ECTRIMS 2022, 26–28 October, Amsterdam, the Netherlands.
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Table of Contents: ECTRIMS 2022
Featured articles
Letter from the Editor
Diagnosis and Prediction of Disease Course
A case for including optic nerve lesions in the McDonald criteria
Cerebrospinal fluid kappa-free light chains for MS diagnosis
Early, non-disabling relapses increase disability accumulation
Physical impairment is present before perceived MS onset
Chronic active MS lesions respond poorly to anti-CD20 antibodies
Treatment: Trials & Strategies
Dimethyl fumarate reduces the risk of a first clinical event in RIS
How and when to make a timely switch to high-efficacy DMT
Comparing real-world effectiveness of DMTs
Study fails to show non-inferiority of rituximab to ocrelizumab
Autologous haematopoietic stem cell transplantation versus DMTs
Progressive MS
Stem cell transplantation not superior to natalizumab in progressive MS
Efficacy of DMTs fades away in secondary progressive MS
Smartphone tapping can help detect progressive MS
Paediatric MS
Early treatment with DMT effective in paediatric-onset MS
Fingolimod in paediatric MS: results of up to 6 years
Switching treatment after initial platform injectable DMT: real-world data
Pregnancy
Pregnancy and infant outcomes in women receiving ocrelizumab
New safety data of anti-CD20 mAbs around pregnancy
MS activity and pregnancy outcomes after long-term use of natalizumab
NMOSD
Ravulizumab significantly reduced relapses in AQP4+ NMOSD
NMOSD patients are cognitively impaired regardless of serostatus
Evidence-based consensus on pregnancy in NMOSD
COVID-19
COVID-19 and MS: lessons learned thus far
Ocrelizumab and fingolimod increase the risk of COVID-19 and of worse outcomes
Humoral and cellular immune responses after SARS-CoV-2 vaccination
Miscellaneous
Re-myelination strategies in MS still pose many unanswered questions
MS associated with a broader Epstein-Barr virus specific T-cell receptor repertoire
Cognitive rehab and mindfulness reduce cognitive complaints in MS
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