Congress highlights: Update on MS medications – ECTRIMS 2017
Highlights from the 7th Joint ECTRIMS-ACTRIMS MEETING, OCTOBER 25-28, Paris, France
A great deal of new information about MS medications was presented at the 2017 ECTRIMS-ACTRIMS congress, the year’s largest conference on MS research. Many of the current therapies have been available for years, so many studies have reported on how well people have done over a prolonged period of treatment. The following is a summary of some of the highlights from these long-term studies.
An international group of MS doctors pooled the results from their clinics to gain some sense of what happens to people during the course of their illness (Kalincik and colleagues. ECTRIMS 2017; abstract P732). In their analysis of over 2,000 people, they found that staying on treatment reduced the risk of disability worsening by about 40% over a 22-year period, and increased a person’s chance of having improvements in their disability by the same amount. However, treatment did not appear to reduce the risk of developing secondary-progressive MS, the phase of the disease when there’s a steady accumulation of disability caused by nerve damage.
Aubagio: People enrolled in the early studies of Aubagio have now been on treatment for up to 14 years, have had MS for over 20 years, and are now in their 50s. Overall, about 70% of people have had little or no change in their level of disability over the longer term (Freedman and colleagues. ECTRIMS 2017; abstract P1203). A separate study also found that people experienced improvements in cognition (thinking, planning, remembering) while on sustained treatment with Aubagio (Sprenger et al. ECTRIMS 2017; abstract P685). In part, this may be because Aubagio has been shown to slow the accumulation of tissue damage in the parts of the brain that are involved in cognition (Zivadinov and colleagues. ECTRIMS 2017; abstract P671).
Tecfidera: Many people now start treatment with Tecfidera, so a study has looked at how well these previously untreated people did over an 8-year period (Gold et al. ECTRIMS 2017; abstract P661). On average, the relapse rate over this time period was 0.14 (i.e. 14% of people had a relapse in any given year). The level of disability was generally stable, with about 50% having no relapses or worsening disability, and over 90% of people continuing to have little accumulated disability over the course of 8 years.
Gilenya: A long-term analysis of one of the key studies of Gilenya reported that in the group starting off with some disability, about 37% had less disability after 8 years of treatment (Cree and colleagues. ECTRIMS 2017; abstract P672). Just over 50% had improvement in some area of functioning, such as walking ability or upper limb movement. A separate study looked at the quality of recovery with Gilenya: disability levels were improved or stable in 54%, fluctuating in 17%, and worse in 29% over an 8-year period.
Zinbryta: This is one of the newer MS medications, which is injected once a month. Over 6 years of treatment, relapse rates have remained consistently low and about 60% of people have experienced no relapses (Kappos and colleagues. ECTRIMS 2017; abstract P731). About 79% taking Zinbryta continuously have experienced no worsening of their disability.
Lemtrada: Clinical studies of Lemtrada have now been running for 7 years, and researchers have found that a majority of people have not needed additional treatment after the initial two courses. (Lemtrada is dosed over a 5-day period in year 1, and for three days in year 2.) Despite not receiving treatment for 5 years, relapses have remained uncommon, 69-74% have not experiencing any worsening of their disability, and 21-44% have shown some improvement in their level of disability (Coles and colleagues. ECTRIMS 2017; abstract P1188; and Singer and colleagues. ECTRIMS 2017; abstract P736). About two-thirds of people had no new lesions on their MRI (Arnold and colleagues. ECTRIMS 2017; abstract P1189; and Pelletier and colleagues ECTRIMS 2017; abstract P741). A separate study found that about 3% of people taking Lemtrada developed secondary-progressive MS over a 6-year period (Horakova and colleagues. ECTRIMS 2017; abstract P1195). This is significantly better than what has been reported for people with MS who receive no treatment: an estimated 2-3% of people with relapsing-remitting MS develop SPMS each year (Vukusic & Confavreux. J Neurol Sci 2003; 206:135-137).
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