A recent study of relapsing remitting multiple sclerosis patients treated with fingolimod, natalizumab, or alemtuzumab found they were less likely to convert to secondary progressive MS (SPMS) compared to those being treated with interferon beta or glatiramer acetate.
The study, published in the journal JAMA, set out to determine the association between the use, the type of, and the timing of DMTs with the risk of conversion to SPMS.
One thousand, five hundred and fifty-five RRMS patients from 21 countries took part in the study. The results revealed that patients initially treated with glatiramer acetate or interferon beta had a lower hazard of conversion (12%) to SPMS than matched untreated patients (27%).
Initial treatment with fingolimod (Gilenya), alemtuzumab (Lemtrada), or natalizumab (Tysabri) was associated with a lower risk of conversion (7%) than initial treatment with glatiramer acetate or interferon beta (12%). The probability of conversion was lower when glatiramer acetate or interferon beta was started within five years of disease onset versus later. When glatiramer acetate or interferon beta were escalated to fingolimod, alemtuzumab, or natalizumab within five years versus later, the hazard ratio was 0.76.
Currently interferon beta and glatiramer acetate are a first tier treatment for RRMS. Fingolimod is a second tier drug and alemtuzumab and natalizumab are part of the top tier of drugs neurologists can prescribe to patients. Depending on how active a patients MS is, their neurologist will suggest a drug to suit. Some of these lower tier drugs have only a 30% success rate in reducing relapses, whereas some of the higher tiered drugs, such as alemtuzumab has showed it can reduce relapses by 70% versus a placebo.
Researchers concluded that these findings, considered along with these therapies’ risks, may help inform decisions about disease modifying therapy selection.
Source: MS-UK, 23/01/2019