Early initiation of highly active treatment associated with a lower risk of SPMS

A French, retrospective, multicentric register study evaluated the long-term impact of the early use of high-efficacy therapy (HET) on the occurrence of secondary progressive MS (SPMS). After 10 years, only 8.0% of patients treated early with HET converted to SPMS. This percentage is lower than would be expected when looking at the known natural history of MS, making the authors advocate for early introduction of HET in younger patients.

The so-called SPAM study, presented by Dr Christine Lebrun-Frenay (CHU de Nice, France), aimed to evaluate the long-term effect of early HET on the risk of transition to SPMS [1]. The study included 2,237 patients from 34 French centres. Participants had to have an EDSS score <4, initiate a HET within the first 5 years after clinical MS onset, and remain on treatment for ≥1 year.

At HET initiation, mean age was 31.6 years, median EDSS score was 2.0, mean disease duration was 2.0 years, and mean follow-up was 5.8 years. The most prescribed HETs were natalizumab (48.1%), fingolimod (36.2%), and ocrelizumab (13.7%).

After 10 years, 59.2% of participants were still using the same HET. At 5 and 10 years, 3.8% and 8.0% of patients had developed SPMS, respectively. Whether HET was used as a first- or second-line treatment did not make a difference for the prognosis (P=0.905). Women had a lower risk of developing SPMS than men (HR 0.64; P=0.036). Older age (HR 2.26; P=0.003), EDSS score ≥1 (HR 7.44, P<0.001), and use of oral HET (HR 1.97; P=0.003) all increased the risk of SPMS.

After 2 years, 50.1% of participants had reached no evidence of disease activity (NEDA), and 24.1% had mild evidence of disease activity (MEDA) at that point. Neither NEDA nor MEDA was associated with SPMS risk. On the other hand, progression independent of relapse activity (PIRA), progression independent of any inflammatory activity (PIA), and relapse-associated worsening (RAW) were all associated with SPMS risk.

Dr Lebrun-Frenay stressed that introducing HET in younger patients before any residual disability based on EDSS (and not on relapses, disease duration, and/or MRI features) is associated with a lower risk of SPMS.

1. Lebrun-Frenay C. Silent progression activity monitoring in MS despite an early highly active treatment: the SPAM study. O043, MSMilan 2023, 11–13 October, Milan, Italy.

 

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Posted on 4 December 20234 December 2023