Efficacy of DMTs fades away in secondary progressive MS

A large study that combined data from 9 registries concluded that disease-modifying therapies (DMTs) may be beneficial during the early stages of progression in secondary progressive MS (SPMS), but their effect seems to fade away with time, over the follow-up years.

The investigators combined data from 8 registries of as many European countries, plus the MSBase registry (msbase.org). The number of patients (total 10,238) each registry contributed varied greatly: from 15 from the UK, to 2,337 from Italy, and 3,236 from France. Included patients were at least 18 years of age, had clinically defined SPMS, and were divided into treated and untreated patients. Participants were classified as treated if they had been on DMTs for at least 80% of the time during the 2-year index period (2015 and 2016) and if they were on a DMT at the index date (1 January 2017). The influence of DMTs on Expanded Disability Status Scale (EDSS) score trajectories was evaluated over a 4-year follow-up period. The data collected in each registry was converted into a standardised format, the so-called common data model (CDM). A linear mixed effect (LME) model was used to analyse EDSS trajectories and DMT effects. Dr Luigi Pontieri (The Danish Multiple Sclerosis Registry, Denmark) presented the results [1].

Compared with untreated participants, treated participants were generally younger at index date, had a shorter disease duration, and had less often SPMS. Results from the LME model indicated that treated participants had a lower EDSS score at index date (untreated group coefficient; registry range 0.12–0.74 point/year]. Unsurprisingly, their EDSS score generally increased during follow-up (time coefficient; registry range 0.04–0.18 point/year). Staying on DMTs did not have a significant effect on the EDSS score (time treatment coefficient; treated group as reference; registry range -0.064–0.1000 point/year); this effect was significantly negative in the Czech and MSbase registries.

In conclusion, untreated SPMS participants generally had higher EDSS scores than treated participants, suggesting a beneficial effect of DMTs in slowing disease accumulation at the earlier stage of progressive MS. However, as participants got older, continuing DMT did not seem to slow EDSS progression. These results stress the importance of earlier recognition and intervention of patients transitioning to progressive MS.

1. Pontieri L, et al. Influence of disease modifying therapies on expanded disability status scale scores trajectories in treated and not-treated patients with secondary Progressive multiple sclerosis - analysis from nine registries. Abstract O065, ECTRIMS 2022, 26–28 October, Amsterdam, the Netherlands.

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Posted on 20 December 202225 March 2024