Patients with aggressive onset multiple sclerosis (AOMS), characterised by a rapidly progressing disease course and accumulation of disability, may benefit from early aggressive therapies instead of the escalation approach commonly given multiple sclerosis (MS) patients, according to researchers at Weill-Cornell Medical College.
Their article, titled “A study of patients with aggressive multiple sclerosis at disease onset,” was published in the journal Neuropsychiatric Disease and Treatment.
Weill researchers selected a set of criteria that could be easily applied in clinical practice to diagnose AOMS within one year of diagnosis. They are: two or more relapses in the year after onset, and two or more gadolinium-enhancing lesions seen in brain magnetic resonance imaging (MRI); or one relapse that results in sustained baseline EDSS (Expanded Disability Status Scale) score of 3, plus two or more gadolinium-enhancing lesions.
The researchers used their criteria to identify AOMS among the 783 patients in the Weill-Cornell Medical College MS database, determining that 58 (7.4%) had aggressive disease. Among these patients, 43 were included in the study, with a mean followup of 54 months.
Results revealed that of the 35 patients (81%) who were treated with traditional first-line therapies, only two showed no evidence of disease activity. Twenty-two were refractory to treatment and switched to a more aggressive therapy, including Tysabri (natalizumab), Rituxan (rituximab), Lemtrada (alemtuzumab), and Cytoxan (cyclophosphamide).
The remaining eight patients (19%) were started on aggressive therapy at disease onset, and seven (87.5%) did not exhibit disease activity at their last follow-up.
These results suggest that AOMS patients may not benefit from a conventional escalation therapy approach, the researchers said, and should be treated with an early aggressive treatment or with an induction followed by maintenance therapy to better control their disease progression.
Source: Multiple Sclerosis News Today © Copyright 2014 - 2016 BioNews Services, LLC (08/08/16)