Early Intensive Treatment vs Escalation: Which is More Effective for RRMS?

Early intensive treatment (EIT) with disease-modifying therapies (DMT) appears to be more effective in slowing the progression of disability compared with moderate-efficacy treatment followed by escalation (ESC) to a higher-efficacy DMT among patients with relapsing-remitting multiple sclerosis (MS), according to new findings presented at MSVirtual2020.

According to the authors of the study, the effect of EIT appeared to increase over time and to yield better outcomes, even after patients in the ESC group were escalated to a higher-efficacy DMT. The new data provide evidence for when and how aggressively to treat RRMS, as no consensus currently exists, the authors noted.

They arrived at their conclusion after evaluating 2652 patients with RRMS across 62 multiple sclerosis (MS) centers in Italy. Data were obtained from the Italian MS Registry. Patients with RRMS who had at least 5 years of follow-up data, at least 3 visits following DMT initiation, and a first visit within 3 years following the onset of disease were included.

Patients in the EIT group had received either natalizumab, fingolimod, alemtuzumab, mitoxantrone, cladribine, or ocrelizumab as their first DMT, whereas patients in the ESC group had received a high efficacy DMT after at least 1 year of treatment with interferons, glatiramer acetate, teriflunomide, azathioprine, or dimethyl fumarate.

A longitudinal model for repeated measures was applied using an autoregressive variance-covariance structure in order to assess disability trajectories. Changes in the mean annual Expanded Disability Status Scale (EDSS) from baseline (Δ-EDSS) were used to evaluate the impact of early vs late initiation of high-efficacy DMTs between treatment groups. Patients were propensity score-matched, yielding 365 pairs.

The results of the study indicated that all patients in the ESC group had escalated to a higher-efficacy DMT after a median 5.1 years. Estimated EDSS scores at baseline were 2.45 and 2.52 in the EIT and ESC groups, respectively. The authors observed that mean Δ-EDSS scores were all significantly higher at each additional 12-month period among ESC patients compared with EIT patients. Mean between-group differences in Δ-EDSS tended to increase from 0.1 to 0.30 to 0.67 at 1 year, 5 years, and 10 years, respectively.

—Christina Vogt

Reference:
Iaffaldano P, Lucisano G, Caputo F, et al. PS01.04 - Comparison of disability trajectories in relapsing multiple sclerosis patients treated with early intensive or escalation treatment strategies. Paper presented at:
Paper presented at: ACTRIMS/ECTRIMS MSVirtual2020; September 11-13, 2020.