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Starting high efficacy treatment early has shown more favourable long-term outcomes compared with escalation of therapy*1–3
A retrospective cohort study of 4861 patients with RRMS from Sweden and Denmark,† initiating their first DMT between 2013–2016,‡ examined the rate of post-baseline 24 weeks CDW between the two groups.§3
Adapted from Spelman T, et al. 2021.
Time to first relapse by treatment-strategy cohort3
Primary outcome: rate of post-baseline 24 weeks CDW§
There was a significant reduction in the Swedish cohort compared to the Danish one (p=0.004) (HR 0.71; 95% CI: 0.57–0.90)3
Adapted from Spelman T, et al. 2021.
Time to first relapse was delayed in the Swedish cohort with the higher proportion of patients initiating HET early3
Discover how treating with high efficacy can positively impact the lives of patients with RRMS
*Better outcomes in terms of CDW, EDSS, ARR and SAD.1–3
†Denmark, N=2161; Sweden, N=2700.3
‡DMT initiated between 1 January 2013 and 31 December 2016. Data were extracted from MS registries on 2 October 2019 (i.e. an observational time of 3–7 years).3
§Time to 24-week CDW was defined as an increase in EDSS score with at least 1 point from baseline (defined as the date that DMT was first started), sustained between two follow-up visits separated by no less than 6 months (1.5 points if the EDSS score at baseline was 0 and 0.5 points if the baseline EDSS score was ≥5.5). Time to 24-week CDW was based on an increase in EDSS that was dependent on the baseline EDSS.3
¶First-line (low–moderate efficacy) DMTs were interferon beta-1a, -1b, pegylated interferon beta-1a, glatiramer acetate, teriflunomide and dimethyl fumarate. Second-line (moderate–high efficacy) DMTs were natalizumab, fingolimod▼, ocrelizumab, rituximab and alemtuzumab.3 Rituximab is not licensed for MS in the UK. Novartis does not endorse the off-label use of any medicines.
ARR, annualised relapse rate; CDW, confirmed disability-worsening; CI, confidence interval; DMT, disease-modifying therapy; EDSS, Expanded Disability Status Scale; HET, high-efficacy treatment; HR, hazard ratio; MS, multiple sclerosis; RRMS, relapsing-remitting multiple sclerosis; SAD, sustained accumulation of disability.
References
- Harding K, et al. JAMA Neurol 2019;76(5):536–541.
- He A, et al. Lancet Neurol 2020;19:307–316.
- Spelman T, et al. JAMA Neurol 2021;78(10):1197–1204 and supplementary material.
