Early intensive treatment enhances long-term clinical outcomes

Results of an Italian register study once again confirmed that early intensive treatment (EIT) enhances long-term clinical outcomes by minimising the accumulation of neurological damage. The greater benefit from EIT compared with escalation therapy (ESC) continued to increase over time, despite the fact that all participants switched to a high-efficacy therapy at some point.

The observational study presented by Dr Pietro Iaffaldano (University of Bari, Italy), compared the long-term effect of EIT with ESC on disability trajectories over time; specifically, on time to first 6-month confirmed disability accrual (CDA), on progression independent of relapse activity (PIRA), and on relapse-associated worsening (RAW) [1].

From the Italian Multiple Sclerosis Register, the researchers extracted data of 4,878 patients with relapsing-onset MS, ≥5 years of follow-up, a first disease-modifying therapy (DMT) prescription within 3 years from onset, and a score ≥3 on the Expanded Disability Status Scale (EDSS) at baseline. The first prescribed DMT determined if patients were classified in the EIT or the ESC group. A total of 908 propensity score-matched pairs were established. In the ESC group, the first DMT (before ESC) was interferon beta in 655 (72%) patients and glatiramer acetate in 163 (18%). In the EIT group, the first DMT in most cases was natalizumab (n=498; 55%), followed by fingolimod (n=241; 27%).

A 10-year comparison of disability trajectories revealed that mean EDSS differences between ESC and EIT groups tended to increase between year 1 and year 10 (see Figure).

Figure: Ten-year comparison of disability trajectories between ESC and EIT [1]



DMT, disease-modifying therapy; EDSS, Expanded Disability Status Scale; EIT, early intensive treatment; ESC, escalation therapy.

Comparing ESC and EIT by Cox proportional hazard regression showed that patients in the ESC group were at a significantly higher risk to reach a first CDA event (HR 1.36; 95% CI 1.20–1.54; P<0.0001), both relapse-dependent and relapse-independent; a first PIRA event (HR 1.22; 95% CI 1.05–1.40; P=0.01); and a first RAW event (HR 1.55; 95% CI 1.17–2.05; P<0.01).

Dr Iaffaldano said that further studies to establish the long-term safety of the EIT approach are warranted. However, he hoped that these findings may drive the treatment decisions of neurologists, especially in treatment-naïve patients with an unfavourable prognosis.

1. Iaffaldano P, et al. Ten-year comparison of disability trajectories in multiple sclerosis patients treated with early intensive and escalation approach: a study from the Italian MS Register. O070, MSMilan 2023, 11–13 October, Milan, Italy.

 

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Posted on 4 December, 20234 December, 2023