Once a patient with relapsing remitting multiples sclerosis (RRMS) transitions to secondary progressive multiple sclerosis (SPMS), no currently approved immunotherapies can slow it down. New research has identified 2 therapies that appear to extend the time to disease conversion—or perhaps prevent it entirely. The study was presented at the 2017 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) annual meeting in Paris on October 26 (128).

Injectable. (Source: Creative Commons)

Researchers analyzed 486 patients with RRMS in the MSBase who were treated for a minimum of 4 years with only one disease-modifying therapy (DMT). Of those, 240 received injectable medications (either interferons or glatiramer acetate), 109 were treated with fingolimod, 93 received natalizumab and 44 were on alemtuzumab. Each patient was propensity matched to a patient with RRMS from a historical cohort and to similar patients treated with a different DMT. The researchers limited the injectables group to patients who received follow-up before more effective treatments came on the market in 2006. They did this in order to reduce the risk that the data would be skewed by a disproportionate number of patients with milder disease.

The researchers found that the injectables, fingolimod, natulizumab and alemtuzumab, all significantly reduced the risk of conversion from RRMS to SPMS compared to no treatment. Among treated patients, alemtuzumab and natalizumab equally reduced development of SPMS. When compared to the other therapies, alemtuzumab and natalizumab cut the risk of conversion by 35% over a follow-up period of 5.7 years.

“SPMS is—at least partially—a consequence of early inflammation…and the risk of conversion from RRMS to SOMS is modifiable over 5 years with existing DMTs, more so with high-efficacy therapies, alemtuzumab and natalizumab,” the authors concluded.