Should you prescribe high efficacy disease modifying therapies (DMTs) for patients with relapsing remitting multiple sclerosis (RRMS) shortly after diagnosis or reserve them for use once resistance to first-line therapies develop? An international team of researchers presented a nuanced answer to the question at the 2017 European Committee on Treatment and Research in Multiple Sclerosis (ECTRIMS) annual meeting in Paris (abstract 231).

Brain scans.

Using the global MSBase cohort study, the researchers compared relapse and disability outcomes between 430 patients who started alemtuzumab, natalizumab or fingolimod (high-efficacy DMTs) and 1295 patients who started low-efficacy DMTs in the first 4 years after diagnosis. They also compared 619 patients who commenced high-efficacy DMTs with 4 years of diagnosis to 1210 patients who started high-efficacy therapies 6 years or more after diagnosis. In addition, they assessed the relationship between annualized relapse rates and disease outcomes in 500 patients who received high-efficacy DMTs versus 1949 who received low-efficacy DMTs.

They found that patients who started high-efficacy DMTs within 4 years of diagnosis had about half the annualized rate of relapse (0.22 vs 0.42) compared to those who started with low-efficacy DMTs and were 50% more likely to recover from disability.

The researchers did not find any difference in relapse rates and disability outcomes between patients who started high-efficacy DMTs within 4 years of diagnosis and those who began the high-efficacy therapies 6 years or more after diagnosis. Their analysis also discovered that the difference in annualized relapse rates between patients on high- versus low-efficacy DMTs declined over time and that there was no “time-dependent flux in disability outcomes,” they said.