How well do meds work over the long term? – ECTRIMS 2018
Highlights from the 34th congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), OCTOBER 10-12, Berlin, Germany – Medications that control the inflammatory flare-ups in multiple sclerosis have been available for 25 years – long enough to provide some indication of whether they slow the development of disability over the longer term. Several studies presented at ECTRIMS addressed this all-important issue.
A study in France looked at over 2,000 people who had been treated for a median of 15 years (Rollot and colleagues. ECTRIMS 2018; abstract P677). People were in their early thirties when they started a medication, most commonly one of the injectables (an interferon or Copaxone) since other drugs weren’t available yet. The people who had the lowest risk of developing disability were those who remained on treatment for 2-10 years. Using a medication for a short time had little impact over the longer term – the benefit of treatment appeared to be due to a cumulative effect.
Two other studies reported similar findings. A Canadian analysis found that long-term medication use was associated with fewer relapses (Marriott and colleagues. ECTRIMS 2018; abstract P999). A U.S. study found that cumulative drug exposure was associated with a slower rate of tissue damage in the brain, although the drug effect was small (Azevedo and colleagues. ECTRIMS 2018; abstract P1188).
Second-generation medications (beginning with Tysabri in 2005) are generally more effective than the injectable drugs, but does this translate to less disability? A Danish study looked at people who were still having relapses on a moderately effective drug and were then switched to a similar drug or to one that’s more potent (Chalmer and colleagues. ECTRIMS 2018; abstract 263). Over a 3-year period, the people who switched to a more potent drug had a 40% lower risk of having a relapse. More importantly, their risk of worsening disability was lower by 13% compared to people on a less potent medication.
How do people do over the longer term on different treatments? One study looked at people who had just been diagnosed when they started on Tecfidera (Gold and colleagues. ECTRIMS 2018; abstract P920). After a median of 9 years, about 83% of people taking Tecfidera continuously had no worsening of their disability, and 93% maintained their walking ability. However, 50% of the original group remained in the study and 50% dropped out.
For people taking Gilenya for at least 5 years, 78% showed no worsening of their disability (Kappos and colleagues. ECTRIMS 2018; abstract P916). Treatment also stabilized the rate of tissue loss in the brain.
A Swedish study reported on 2,306 people treated with Tysabri for a median of 6 years (Manouchehrinia and colleagues. ECTRIMS 2018; abstract P881). Disability scores slowly worsened over time but at a much slower rate than historical rates of people who are untreated or who are taking another type of medication.
People in one of the original studies of Lemtrada have now been followed for 8 years (Singer and colleagues. ECTRIMS 2018; abstract P913). After two courses of treatment in the first two years, 44% have not needed any additional medication. By year 8, there was a slight worsening of disability but 64% of people have stable or improved disability scores.
The newest MS medication is Ocrevus, and some people have now been on treatment for up to 5 years (Hauser and colleagues. ECTRIMS 2018; abstract P590). The proportion of people taking Ocrevus continuously who have had worsening disability has doubled over the years, from about 8% in the first year to 16% in the fifth year. However, 1 in 4 people has seen some improvement in disability with treatment.
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