Interferons Superior to Glatiramer Acetate, and Tysabri More Effective than Gilenya for RRMS, Real-world Study Finds

Interferons Superior to Glatiramer Acetate, and Tysabri More Effective than Gilenya for RRMS, Real-world Study Finds

Interferon therapy (brand names Avonex, Betaseron, and others) is more effective than glatiramer acetate (sold as Copaxone, Glatopa and other generics) for reducing relapses and disease activity, and delaying disability worsening, in patients with relapsing-remitting multiple sclerosis (RRMS), a large real-world study found.

The study also showed that, in clinical practice, second-line treatment with Tysabri (natalizumab) is more effective than Gilenya (fingolimod).

Real-world studies looking at the effectiveness and safety of treatments on daily clinical practice provide important, long-term insights into how MS therapies perform under real-life conditions. That is why real-world data is an important complement to clinical trial studies, in which conditions and patient populations are very controlled and restricted.

In Poland, treatments for RRMS are reimbursed and strictly regulated by the Polish National Health Service. First-line disease-modifying therapies (DMTs) covered include injectable interferon beta (IFN-beta), Plegridy (pegylated interferon beta), or glatiramer acetate, and oral treatment with Tecfidera (dimethyl fumarate) or Aubagio (teriflunomide).

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For patients who do not respond to these therapies, second-line options are Tysabri and Gilenya.

Because access to MS treatment programs in Poland is more stringent compared to other European countries, the effectiveness of DMTs in real-life practice could differ compared to other countries. For instance, due to the restrictive criteria for escalating to second-line therapy, only a small number of patients have been treated with Tysabri or Gilenya.

To study MS therapies’ effectiveness under real-life conditions in Poland, a team of researchers conducted a nationwide study including 10,764 RRMS patients undergoing first-line treatment, and 1,042 patients on second-line programs.

They compared the effectiveness of interferon beta (77.6% patients) versus glatiramer acetate (22.4%), and of Tysabri (34.4%) versus Gilenya (65.6%), in terms of the frequency of relapses, disability progression, and active brain lesions on magnetic resonance imaging (MRI). Data was collected from 2014 to 2018.

Results revealed that treatment with interferon beta was more effective than with glatiramer acetate at extending the time to relapse, delaying disability progression, and reducing brain MRI activity.

Among patients treated with interferon-beta, the proportion of relapse-free patients at two years was estimated at 85%, compared with 78% for those on glatiramer acetate. At four years, 80% of those treated with interferon-beta and 76.4% of those treated with glatiramer acetate did not experience disability worsening, as measured by the Expanded Disability Status Scale (EDSS).

Likewise, over that time, the proportion of patients with new active lesions (gadolinium-positive) also was lower in patients treated with interferon beta — 19.1% versus 28.9% in the glatiramer acetate group after four years.

In agreement, patients on interferon were more likely to have no evidence of disease activity (NEDA-3), defined as no relapses, no brain MRI activity, and no disability worsening — 66.3% vs. 55.2% in the glatiramer acetate group at two years, and 44.3% vs. 33.2%, respectively, at four years of treatment.

The study also indicated that Tysabri was superior to Gilenya. More patients were relapse-free under Tysabri (80.8%) than Gilenya (76.5%), and a greater proportion of those on Tysabri (83.1%) had no disability progression after two years of treatment, compared with Gilenya (79.6%).

Moreover, Tysabri reduced brain MRI activity more effectively, with new brain lesions appearing in 7.2% of patients, compared to 22.7% in those treated with Gilenya, through the four years of treatment.

Consistent with this, more patients under Tysabri reached no disease activity (NEDA-3) — 66.2% versus 52.1% with Gilenya after two years of treatment, and 42.1% versus 29.5% with Gilenya after four years.

Overall, the data shows that in a Polish population of RRMS patients, interferon and Tysabri were the first- and second-line treatments that “more effectively reduced disease activity,” compared to glatiramer acetate and Gilenya.

Because Tysabri and Gilenya reduced clinical and radiological disease activity compared to first-line injectables, researchers called on Polish authorities to increase access to second-line therapies as they can be more effective.

Results from the study also add that age is a risk factor for disability progression in MS, and that the most important predictor of disease activity is the patients’ disability level (EDSS), which relates to how often they have relapses and how likely they are to fail reaching NEDA-3.

Ana is a molecular biologist with a passion for discovery and communication. As a science writer she looks for connecting the public, in particular patient and healthcare communities, with clear and quality information about the latest medical advances. Ana holds a PhD in Biomedical Sciences from the University of Lisbon, Portugal, where she specialized in genetics, molecular biology, and infectious diseases
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Patrícia holds her PhD in Medical Microbiology and Infectious Diseases from the Leiden University Medical Center in Leiden, The Netherlands. She has studied Applied Biology at Universidade do Minho and was a postdoctoral research fellow at Instituto de Medicina Molecular in Lisbon, Portugal. Her work has been focused on molecular genetic traits of infectious agents such as viruses and parasites.
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Ana is a molecular biologist with a passion for discovery and communication. As a science writer she looks for connecting the public, in particular patient and healthcare communities, with clear and quality information about the latest medical advances. Ana holds a PhD in Biomedical Sciences from the University of Lisbon, Portugal, where she specialized in genetics, molecular biology, and infectious diseases
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2 comments

  1. Traci Easton says:

    I went from Rebif to Tysabri because of the amount of exasperbations within the first year of my diagnosis. That turned out to be my `Lamborghini’ DMT. Unfortunately, being JC+ when I started didn’t allow me to keep on it any more than 16 months,no matter how much bartering I did. 🙁

  2. anon says:

    Interesting, but how discouraging to see any focus on creaky old injectable therapies. Patients are non-compliant with injecting Avonex and Copaxone for countless good reasons.

    When will someone do a study on tissue damage caused by using injectables year after year? Or a study about how stressful it is to cycle through flu-like Avonex symptoms once a week?

    Not trying to say that injectables shouldn’t be options. But will anything ever move the dial forward in terms of doable, safe, and effective treatments?

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