Switching treatment after initial platform injectable DMT: real-world data

A cohort study of children with MS or clinically isolated syndrome (CIS) assessed real-world effectiveness of switching treatment in patients initially treated with a platform injectable disease-modifying therapy (DMT). The results support escalating to a higher-efficacy DMT, which leads to better disease activity control. Long-term safety data for oral and infusion DMTs are required.

Most DMTs lack efficacy data in children, which makes paediatric-onset MS (POMS) treatment challenging. The use of newer DMTs in POMS lags behind from that in adults, though a large, retrospective analysis supports the use of newer DMTs over injectables in POMS [1]. Data on switching DMTs in POMS is, however, scarce. A cohort study of children with MS or CIS at 12 US clinics was set up to compare the real-world effectiveness of switching from platform injectable (interferon-β or glatiramer acetate) to oral (dimethyl fumarate, fingolimod, or teriflunomide) or infusion therapy (natalizumab, rituximab, ocrelizumab, or alemtuzumab) versus switching to other injectable DMT [2].

Overall, 212 children whose first treatment was a platform injectable and who switched DMT before they were 18 years, were included in the analysis. They were stratified into 3 groups: 1) switchers to another injectable (n=93); 2) switchers to an oral DMT (n=76); and 3) switchers to infusion DMT (n=43). Groups 2 and 3 were older at onset (group 1 12.3 years; group 2 13.5 years; group 3 14.2 years) and switch date (group 1 14.6 years; group 2 16 years; group 3 15.7 years). Participants that switched to infusion were more likely to have new enhancing lesions prior to switching (group 1 45%; group 2 28%; group 3 67%). Follow-up was up to 4 years.

The primary outcome was the annualised relapse rate (ARR), which was 0.59 in group 1, 0.22 in group 2, and 0.15 in group 3. Results were similar for the adjusted analysis (see Table).

Table: Adjusted primary analysis outcomes [2]



NNT, number needed to treat.

Secondary outcomes included markers of radiological disease activity. Results were displayed as the time it took for 50% of each group to develop new T2 lesions. In groups 1, 2, and 3 this was 0.49, 1.25, and 1.99 years, respectively.

In conclusion, switching from a platform injectable to an oral or infusion DMT as opposed to another injectable DMT led to better disease activity control of paediatric MS. Long-term safety data for oral and infusion DMTs are required.

1. Krysko KM, et al. Ann Neurol. 2020;88(1):42–55.
2. Abrams A. Real-world effectiveness of switching treatment after initial platform injectable disease-modifying therapies in pediatric multiple sclerosis in the US. Abstract O070, ECTRIMS 2022, 26–28 October, Amsterdam, the Netherlands.

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Posted on 20 December 20227 September 2023