Congress update: Higher-potency MS medications
The following is a summary about some of research on higher-potency disease-modifying therapies (DMT) for relapsing-remitting MS presented at this year’s meeting of the American Academy of Neurology (AAN).
Tysabri: The MS PATHS study looked at the quality of life in people taking Tysabri. Among those with life quality issues, about 43% reported improvements in their sense of well-being, and about one-third noted improvements in sleep and anxiety (Hersh and colleagues. AAN 2021; abstract P15.023).
MS PATHS also looked at whether taking Tysabri less frequently (i.e. less often than once a month) was effective (Ryerson and colleagues. AAN 2021; P15.210). The researchers found that the lower dose of Tysabri was as effective as the standard dose in suppressing new lesions and reducing tissue loss as seen on an MRI. A separate analysis of the Tysabri database also found that less frequent dosing (called extended-interval dosing, or EID) reduced the risk of developing PML (progressive multifocal leukoencephalopathy), a potentially fatal brain infection caused by the JC virus (Ryerson and colleagues. AAN 2021; abstract P.15.201). In the first four years of treatment, there were no PML cases with extended-interval dosing compared to 1.93 cases per 1000 (0.19%) with the usual dose.
Ocrevus: A safety analysis looked at adverse events in people enrolled in clinical trials followed for up to seven years (Hauser and colleagues. AAN; abstract 15.203). Results were for the period ending in January 2020 (prior to the pandemic). The rate of infections declined over time although the rate of serious infections was about two-fold higher. Infusion-related reactions were less common. The rate of malignancy increased slightly (to 0.46% per year); the incidence ratio for breast cancer was low but significantly higher than in the overall population of people with MS. About 1% of people stopped treatment due to adverse events.
Mavenclad: A safety analysis examined the rate of respiratory infections (including COVID) during treatment with Mavenclad (Giovannoni and colleagues. AAN 2021; abstract 15.196). The rate of respiratory infections with cladribine was similar to what was seen with a placebo. However, it should be noted that Mavenclad is only administered for two years, and 85% of people have been in the study for 2-9 years, meaning that many have not been exposed to the drug for quite some time. The study also reported on the 261 people on Mavenclad who have contracted COVID-19. Overall, 40 people (15%) developed severe COVID, including 25 people who needed to be hospitalized. There was one death.
Gilenya vs. Tysabri: An analysis of MS patient registries looked at how well people did on Gilenya compared to Tysabri (Sharmin and colleagues. AAN 2021; abstract 15.073). People generally experienced fewer relapses while on Tysabri; those who benefited the most were younger women treated in the first seven years of their disease. The risk of worsening disability was comparable with the two medications. Both drugs also had similar effects in people with progressive MS.
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