Recent research on multiple sclerosis (MS) indicates that newly diagnosed patients receiving B-cell-depleting therapies or high-efficacy treatments exhibit fewer relapses and reduced brain lesions compared to those on oral therapies. However, after two years, the disability outcomes across these treatment modalities seem to converge, according to prospective data from the MultipleMS cohort study.
Effectiveness of Treatments
In comparison to oral platform therapies, B-cell-depleting treatments demonstrated a significant reduction in relapse incidence (incidence rate ratio 0.38, 95% CI 0.15–0.92) and a notable decrease in T2 lesion volume (volume ratio 0.87, 95% CI 0.76–0.99), as reported by Dr. Fredrik Piehl from the Karolinska Institute in Stockholm and his colleagues in Neurology Open Access.
The changes in disability scores and serum neurofilament light (NfL)—a biomarker for axonal injury—showed no significant differences among the various treatment groups. However, modest decreases in serum glial fibrillary acidic protein (GFAP), indicative of astroglial activation, were observed, with more substantial reductions in patients on oral therapies.
Dr. Piehl mentioned, “The treatment groups already differed in important patient characteristics, suggesting that doctors were to some extent selecting treatments based on the individual patient.” Thus, while aggressive treatments correlated with reduced relapses and MRI alterations, clear disparities in disability scores were not observed after two years.
The Challenge of Quantifying Disability
The introduction of disease-modifying therapies (DMTs) has significantly impacted MS management by aiming to reduce inflammation and inhibit progression. Nonetheless, quantifying the worsening of disability in MS remains challenging. The researchers highlighted that proxies like NfL correlate with inflammatory activity, whereas GFAP may be more closely aligned with progression independent of relapse.
Research suggests that while high-efficacy and B-cell-depleting therapies effectively manage acute inflammation, they may not efficiently address chronic neuroinflammation. This observation highlights a critical therapeutic gap that needs to be addressed.
Dr. Carmen Tur from the Multiple Sclerosis Centre of Catalonia pointed out that chronic inflammation’s evolution appears to occur largely independently of acute inflammatory activities.
Study Demographics and Parameters
The MultipleMS study observed 509 newly diagnosed MS patients across seven European countries, with the majority (89%) experiencing relapsing-remitting MS. At baseline, the participants had an average age of 33 years and were followed for a duration of two years. Patients began their treatment on various scales, which included injectable platform drugs, oral therapies, high-efficacy treatments, B-cell-depleting therapies, or no treatment at all.
Tracking disability scores employed the Expanded Disability Status Scale (EDSS). At the start of the study, the median EDSS score was 1.5, with a median disease duration of 0.66 years. Notably, initial characteristics significantly influenced DMT selection, particularly for high-efficacy therapies, affecting treatment continuity over the two-year period.
Despite the limitations of observational design, such as lack of randomization and short follow-up duration, Dr. Piehl expressed hope that with extended observation, more definitive differences might emerge over the long term regarding treatment efficacy.
Disclaimer
This content is intended for informational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Fuente: https://www.medpagetoday.com/neurology/multiplesclerosis/122956
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